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de Hoog S, Walsh TJ, Ahmed SA, Alastruey-Izquierdo A, Alexander BD, Arendrup MC, Babady E, Bai FY, Balada-Llasat JM, Borman A, Chowdhary A, Clark A, Colgrove RC, Cornely OA, Dingle TC, Dufresne PJ, Fuller J, Gangneux JP, Gibas C, Glasgow H, Graser Y, Guillot J, Groll AH, Haase G, Hanson K, Harrington A, Hawksworth DL, Hayden RT, Hoenigl M, Hubka V, Johnson K, Kus JV, Li R, Meis JF, Lackner M, Lanternier F, Leal SM, Lee F, Lockhart SR, Luethy P, Martin I, Kwon-Chung KJ, Meyer W, Nguyen MH, Ostrosky-Zeichner L, Palavecino E, Pancholi P, Pappas PG, Procop GW, Redhead SA, Rhoads DD, Riedel S, Stevens B, Sullivan KO, Vergidis P, Roilides E, Seyedmousavi A, Tao L, Vicente VA, Vitale RG, Wang QM, Wengenack NL, Westblade L, Wiederhold N, White L, Wojewoda CM, Zhang SX. Reply to Kidd et al., "Inconsistencies within the proposed framework for stabilizing fungal nomenclature risk further confusion". J Clin Microbiol 2024; 62:e0162523. [PMID: 38441056 PMCID: PMC11005378 DOI: 10.1128/jcm.01625-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Sybren de Hoog
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
- Research Center for Medical Mycology, Peking University, Beijing, China
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
| | - Thomas J. Walsh
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Nomenclature Committee for Fungi, International Mycological Association (IMA), Exeter, United Kingdom
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Medical Mycological Society of the Americas (MMSA)
- ISHAM Working Group on Diagnostics, Basel, Switzerland
| | - Sarah A. Ahmed
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
| | - Ana Alastruey-Izquierdo
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Mycology Reference Laboratory, Spanish National Centre for Microbiology, Madrid, Spain
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
| | - Barbara D. Alexander
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Medical Mycological Society of the Americas (MMSA)
- Departments of Medicine and Pathology, Duke University, Durham, North Carolina, USA
| | - Maiken Cavling Arendrup
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
| | - Esther Babady
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, Clinical Microbiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Feng-Yan Bai
- Mycology Committee of Chinese Society for Microbiology, Beijing, China
- Institute of Microbiology, State Key Laboratory of Mycology, Chinese Academy of Sciences, Beijing, China
- Medical Mycology Society of Chinese Medicine and Education Association
- Asia PacificSociety for Medical Mycology
- ISHAM Working Group Veterinary Mycology and One Health, ‘s-Hertogenbosch, the Netherlands
- Mycological Society of China (MSC)
| | - Joan-Miquel Balada-Llasat
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew Borman
- National Mycology Reference Laboratory, Public Health England, Bristol, United Kingdom
| | - Anuradha Chowdhary
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Department of Microbiology, National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Andrew Clark
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert C. Colgrove
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Infectious Diseases Society of America (ISDA), Arlington, Virginia, USA
| | - Oliver A. Cornely
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Tanis C. Dingle
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Alberta Precision Laboratories, Public Health Laboratory, Calgary, Alberta, Canada
| | - Philippe J. Dufresne
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Department of Mycology, Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec (INSPQ), Sainte-Anne-de-Bellevue, Québec, Canada
| | - Jeff Fuller
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario, Canada
| | - Jean-Pierre Gangneux
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Department of Mycology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Connie Gibas
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Heather Glasgow
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Department of Pathology, Clinical and Molecular Microbiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yvonne Graser
- Department of Parasitology (Charité), Institute of Microbiology and Hygiene, Humboldt University, Berlin, Germany
| | - Jacques Guillot
- ISHAM Working Group Veterinary Mycology and One Health, ‘s-Hertogenbosch, the Netherlands
- Onoris, École Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique, Nantes, France
| | - Andreas H. Groll
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Department of Pediatric Hematology and Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children’s Hospital, Münster, Germany
| | - Gerhard Haase
- Laboratory Diagnostic Center, RWTH Aachen University Hospital, Aachen, Germany
| | - Kimberly Hanson
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amanda Harrington
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Loyola University Health System, Loyola University Chicago, Maywood, Illinois, USA
| | - David L. Hawksworth
- Royal Botanic Gardens, Kew, Richmond, Surrey, United Kingdom
- Natural History Museum, London, United Kingdom
- University of Southampton, Southampton, United Kingdom
- Jilin Agricultural University, Chanchung, China
- General Committee for Nomenclature, International Botanical Congress (IBC)
- Advisory Board of International Commission on the Taxonomy of Fungi (ICTF)
| | - Randall T. Hayden
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Department of Pathology, Clinical and Molecular Microbiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Martin Hoenigl
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- European Hematology Association, Specialized Working Group for Infections in Hematology, The Hague, the Netherlands
| | - Vit Hubka
- Department of Botany, Charles University, Prague, Czechia
| | - Kristie Johnson
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julianne V. Kus
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Canada and University of Toronto, Toronto, Ontario, Canada
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- ISHAM Working Group on Diagnostics, Basel, Switzerland
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
- Medical Mycology Society of Chinese Medicine and Education Association
| | - Jacques F. Meis
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- ISHAM Working Group on Diagnostics, Basel, Switzerland
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Michaela Lackner
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sixto M. Leal
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Francesca Lee
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shawn R. Lockhart
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- European Hematology Association, Specialized Working Group for Infections in Hematology, The Hague, the Netherlands
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Luethy
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Isabella Martin
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kyung J. Kwon-Chung
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Wieland Meyer
- Nomenclature Committee for Fungi, International Mycological Association (IMA), Exeter, United Kingdom
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - M. Hong Nguyen
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- Medical Mycological Society of the Americas (MMSA)
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Luis Ostrosky-Zeichner
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Palavecino
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology Laboratory, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Preeti Pancholi
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Peter G. Pappas
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gary W. Procop
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- The American Board of Pathology, Tampa, Florida, USA
- American Board of Pathology (ABP), Chicago, Illinois, USA
| | - Scott A. Redhead
- Nomenclature Committee for Fungi, International Mycological Association (IMA), Exeter, United Kingdom
- National Mycological Herbarium, Ottawa Research and Development Centre, Science and Technology Branch, Agriculture & Agri-Food Canada, Ottawa, Ontario, Canada
| | - Daniel D. Rhoads
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan Riedel
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bryan Stevens
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kaede Ota Sullivan
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Paschalis Vergidis
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mayo Clinic, Rochester, Minnesota, USA
| | - Emmanuel Roilides
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Hippokration Hospital, Thessaloniki, Greece
| | - Amir Seyedmousavi
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- ISHAM Working Group Veterinary Mycology and One Health, ‘s-Hertogenbosch, the Netherlands
- Department of Laboratory Medicine, Microbiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lili Tao
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vania A. Vicente
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Roxana G. Vitale
- Consejo Nacional de Investigaciones Científicasy Tecnológicas (CONICET), Buenos Aires, Argentina
- Unidad de Parasitología, Sector Micología, Hospital J.M. Ramos Mejía, Buenos Aires, Argentina
| | - Qi-Ming Wang
- Engineering Laboratory of Microbial Breeding and Preservation of Hebei Province, School of Life Sciences, Institute of Life Sciences and Green Development, Hebei University, Baoding, China
| | - Nancy L. Wengenack
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mayo Clinic, Rochester, Minnesota, USA
| | - Lars Westblade
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Nathan Wiederhold
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Medical Mycological Society of the Americas (MMSA)
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Lewis White
- Public Health Wales Microbiology, Cardiff, United Kingdom
| | - Christina M. Wojewoda
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Sean X. Zhang
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Miller JM, Binnicker MJ, Campbell S, Carroll KC, Chapin KC, Gonzalez MD, Harrington A, Jerris RC, Kehl SC, Leal SM, Patel R, Pritt BS, Richter SS, Robinson-Dunn B, Snyder JW, Telford S, Theel ES, Thomson RB, Weinstein MP, Yao JD. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis 2024:ciae104. [PMID: 38442248 DOI: 10.1093/cid/ciae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by experts in both adult and pediatric laboratory and clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including arboviral Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. In addition, the pediatric needs of specimen management are also addressed. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.
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Affiliation(s)
| | - Matthew J Binnicker
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sheldon Campbell
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karen C Carroll
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Mark D Gonzalez
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Amanda Harrington
- Department of Pathology and Laboratory Medicine, Loyola University, Chicago, Illinois, USA
| | - Robert C Jerris
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sue C Kehl
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sixto M Leal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bobbi S Pritt
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sandra S Richter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Barbara Robinson-Dunn
- Department of Pathology and Laboratory Medicine (Ret), Beaumont Health, Royal Oak, Michigan, USA
| | - James W Snyder
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Sam Telford
- Department of Infectious Disease and Global Health, Tufts University, North Grafton, MA, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard B Thomson
- Emeritus Staff, NorthShore University Health System, Evanston, Illinois, USA
| | - Melvin P Weinstein
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joseph D Yao
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Masand PS, McIntyre RS, Cutler AJ, Ganz ML, Lorden AL, Patel K, Kramer K, Harrington A, Nguyen HB. Estimating Changes in Weight and Metabolic Parameters Before and After Treatment With Cariprazine: A Retrospective Study of Electronic Health Records. Clin Ther 2024; 46:50-58. [PMID: 38036337 DOI: 10.1016/j.clinthera.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Weight gain and associated negative cardiometabolic effects can occur as a result of mental illness or treatment with second-generation antipsychotics (SGAs), leading to increased rates of morbidity and mortality. In this analysis, we evaluated the effect of the SGA cariprazine on weight and metabolic parameters in a real-world, retrospective, observational dataset. METHODS Electronic health records from the Optum Humedica database (October 1, 2014-December 31, 2020) were analyzed during the 12-month period before starting cariprazine (baseline) and for up to 12 months following cariprazine initiation; approved and off-label indications were included. Body weight trajectories were estimated in the overall patient cohort and at 3-, 6-, and 12-month timepoints (primary objective). Changes in hemoglobin A1c (HbA1c), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides were also evaluated (secondary objectives). Percentages of patients with clinically relevant shifts in body weight, total cholesterol, and fasting triglycerides were also determined. Discontinuation rates for metabolic regulating medications were calculated. Average predicted values were estimated by linear mixed-effects regression models. FINDINGS A total of 2,301 patients were included; average duration of follow-up was 133.7 days. Average predicted weight change for patients during the cariprazine overall follow-up period was +2.4 kg, with predicted weight changes of +0.8 kg (n = 811), +1.1 kg (n = 350), and +1.4 kg (n = 107) at months 3, 6, and 12, respectively. Overall, the majority of patients did not experience clinically significant (≥7%) weight gain (82.8%) or loss (90.5%) after starting cariprazine. Average predicted HbA1c levels (n = 189) increased during baseline (0.15%/year) and decreased during cariprazine treatment (-0.2%/year). Average predicted triglyceride levels (n = 257) increased during baseline (15.0 mg/dL/year) and decreased during cariprazine treatment (-0.7 mg/dL/year). Predicted LDL (n = 247) and HDL (n = 255) values decreased during baseline (-7.3 and -1.1 mg/dL/year, respectively); during cariprazine treatment, LDL increased by 5.6 mg/dL/year and HDL decreased by -0.6 mg/dL/year. During follow-up, most patients did not shift from normal/borderline to high total cholesterol (<240 to ≥240 mg/dL; 522 [90.2%]) or fasting triglyceride (<200 to ≥200 mg/dL; 143 [88.8%] patients) levels; shifts from high to normal/borderline levels occurred in 44 (61.1%) patients for total cholesterol and 38 (57.6%) patients for fasting triglycerides. After starting cariprazine, the discontinuation rate per 100 patient-years was 60.4 for antihyperglycemic medication and 87.4 for hyperlipidemia medication. IMPLICATIONS These real-world results support short-term clinical trial findings describing a neutral weight and metabolic profile associated with cariprazine treatment and they expand the dataset to include long-term follow-up.
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de Hoog S, Walsh TJ, Ahmed SA, Alastruey-Izquierdo A, Alexander BD, Arendrup MC, Babady E, Bai FY, Balada-Llasat JM, Borman A, Chowdhary A, Clark A, Colgrove RC, Cornely OA, Dingle TC, Dufresne PJ, Fuller J, Gangneux JP, Gibas C, Glasgow H, Gräser Y, Guillot J, Groll AH, Haase G, Hanson K, Harrington A, Hawksworth DL, Hayden RT, Hoenigl M, Hubka V, Johnson K, Kus JV, Li R, Meis JF, Lackner M, Lanternier F, Leal Jr. SM, Lee F, Lockhart SR, Luethy P, Martin I, Kwon-Chung KJ, Meyer W, Nguyen MH, Ostrosky-Zeichner L, Palavecino E, Pancholi P, Pappas PG, Procop GW, Redhead SA, Rhoads DD, Riedel S, Stevens B, Sullivan KO, Vergidis P, Roilides E, Seyedmousavi A, Tao L, Vicente VA, Vitale RG, Wang QM, Wengenack NL, Westblade L, Wiederhold N, White L, Wojewoda CM, Zhang SX. A conceptual framework for nomenclatural stability and validity of medically important fungi: a proposed global consensus guideline for fungal name changes supported by ABP, ASM, CLSI, ECMM, ESCMID-EFISG, EUCAST-AFST, FDLC, IDSA, ISHAM, MMSA, and MSGERC. J Clin Microbiol 2023; 61:e0087323. [PMID: 37882528 PMCID: PMC10662369 DOI: 10.1128/jcm.00873-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
The rapid pace of name changes of medically important fungi is creating challenges for clinical laboratories and clinicians involved in patient care. We describe two sources of name change which have different drivers, at the species versus the genus level. Some suggestions are made here to reduce the number of name changes. We urge taxonomists to provide diagnostic markers of taxonomic novelties. Given the instability of phylogenetic trees due to variable taxon sampling, we advocate to maintain genera at the largest possible size. Reporting of identified species in complexes or series should where possible comprise both the name of the overarching species and that of the molecular sibling, often cryptic species. Because the use of different names for the same species will be unavoidable for many years to come, an open access online database of the names of all medically important fungi, with proper nomenclatural designation and synonymy, is essential. We further recommend that while taxonomic discovery continues, the adaptation of new name changes by clinical laboratories and clinicians be reviewed routinely by a standing committee for validation and stability over time, with reference to an open access database, wherein reasons for changes are listed in a transparent way.
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Affiliation(s)
- Sybren de Hoog
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
- Research Center for Medical Mycology, Peking University, Beijing, China
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
| | - Thomas J. Walsh
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Nomenclature Committee for Fungi, International Mycological Association (IMA)
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- European Confederation of Medical Mycology (ECMM)
- Clinical and Laboratory Standards Institute (CLSI)
- Medical Mycological Society of the Americas (MMSA)
- ISHAM Working Group on Diagnostics
| | - Sarah A. Ahmed
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
| | - Ana Alastruey-Izquierdo
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Mycology Reference Laboratory, Spanish National Centre for Microbiology, Madrid, Spain
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
| | - Barbara D. Alexander
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Departments of Medicine and Pathology, Duke University, Durham, North Carolina, USA
| | - Maiken Cavling Arendrup
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
| | - Esther Babady
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Feng-Yan Bai
- Mycology Committee of Chinese Society for Microbiology
- Institute of Microbiology, State Key Laboratory of Mycology, Chinese Academy of Sciences, Beijing, China
- Medical Mycology Society of Chinese Medicine and Education Association
- Asia Pacific Society for Medical Mycology
- ISHAM Working Group Veterinary Mycology and One Health
- Mycological Society of China (MSC)
| | - Joan-Miquel Balada-Llasat
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew Borman
- National Mycology Reference Laboratory, Public Health England, Bristol, United Kingdom
| | - Anuradha Chowdhary
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Department of Microbiology, National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Andrew Clark
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert C. Colgrove
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Infectious Diseases Society of America (ISDA)
| | - Oliver A. Cornely
- European Confederation of Medical Mycology (ECMM)
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Tanis C. Dingle
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- Alberta Precision Laboratories, Public Health Laboratory, Calgary, Alberta, Canada
| | - Philippe J. Dufresne
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- Mycology Department, Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec (INSPQ), Sainte-Anne-de-Bellevue, Québec, Canada
| | - Jeff Fuller
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario, Canada
| | - Jean-Pierre Gangneux
- European Confederation of Medical Mycology (ECMM)
- Department of Mycology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Connie Gibas
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Heather Glasgow
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Molecular Microbiology, Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yvonne Gräser
- Department of Parasitology (Charité), Institute of Microbiology and Hygiene, Humboldt University, Berlin, Germany
| | - Jacques Guillot
- ISHAM Working Group Veterinary Mycology and One Health
- Onoris, École Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique, Nantes, France
| | - Andreas H. Groll
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Infectious Disease Research Program, Department of Pediatric Hematology and Oncology and Center for Bone Marrow Transplantation, University Children’s Hospital, Münster, Germany
| | - Gerhard Haase
- Laboratory Diagnostic Center, RWTH Aachen University Hospital, Aachen, Germany
| | - Kimberly Hanson
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amanda Harrington
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Loyola University Health System, Loyola University Chicago, Maywood, Illinois, USA
| | - David L. Hawksworth
- Royal Botanic Gardens, Kew, Richmond, Surrey, United Kingdom
- Natural History Museum, London, United Kingdom
- University of Southampton, Southampton, United Kingdom
- Jilin Agricultural University, Chanchung, China
- General Committee for Nomenclature, International Botanical Congress (IBC)
- Advisory Board of International Commission on the Taxonomy of Fungi (ICTF)
| | - Randall T. Hayden
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- Clinical and Molecular Microbiology, Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Martin Hoenigl
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- European Confederation of Medical Mycology (ECMM)
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- European Hematology Association, Specialized Working Group for Infections in Hematology, The Hague, the Netherlands
| | - Vit Hubka
- Department of Botany, Charles University, Prague, Czechia
| | - Kristie Johnson
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julianne V. Kus
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Canada and University of Toronto, Toronto, Ontario, Canada
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- ISHAM Working Group on Diagnostics
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
- Medical Mycology Society of Chinese Medicine and Education Association
| | - Jacques F. Meis
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- ISHAM Working Group on Diagnostics
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Michaela Lackner
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sixto M. Leal Jr.
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- Clinical and Laboratory Standards Institute (CLSI)
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Francesca Lee
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shawn R. Lockhart
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Luethy
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Isabella Martin
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kyung J. Kwon-Chung
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Wieland Meyer
- Nomenclature Committee for Fungi, International Mycological Association (IMA)
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - M. Hong Nguyen
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- Medical Mycological Society of the Americas (MMSA)
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Luis Ostrosky-Zeichner
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Palavecino
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Laboratory, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Preeti Pancholi
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Peter G. Pappas
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gary W. Procop
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- The American Board of Pathology, Tampa, Florida, USA
- American Board of Pathology (ABP)
| | - Scott A. Redhead
- Nomenclature Committee for Fungi, International Mycological Association (IMA)
- National Mycological Herbarium, Ottawa Research and Development Centre, Science and Technology Branch, Agriculture & Agri-Food Canada, Ottawa, Ontario, Canada
| | - Daniel D. Rhoads
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan Riedel
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bryan Stevens
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kaede Ota Sullivan
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Paschalis Vergidis
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mayo Clinic, Rochester, Minnesota, USA
| | - Emmanuel Roilides
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- European Confederation of Medical Mycology (ECMM)
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Hippokration Hospital, Thessaloniki, Greece
| | - Amir Seyedmousavi
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- ISHAM Working Group Veterinary Mycology and One Health
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lili Tao
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vania A. Vicente
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Roxana G. Vitale
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
- Unidad de Parasitología, Sector Micología, Hospital J.M. Ramos Mejía, Buenos Aires, Argentina
| | - Qi-Ming Wang
- Engineering Laboratory of Microbial Breeding and Preservation of Hebei Province, School of Life Sciences, Institute of Life Sciences and Green Development, Hebei University, Baoding, China
| | - Nancy L. Wengenack
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mayo Clinic, Rochester, Minnesota, USA
| | - Lars Westblade
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Nathan Wiederhold
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- Clinical and Laboratory Standards Institute (CLSI)
- Medical Mycological Society of the Americas (MMSA)
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Lewis White
- Public Health Wales Microbiology, Cardiff, United Kingdom
| | - Christina M. Wojewoda
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Sean X. Zhang
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jain R, Laliberté F, Germain G, Mahendran M, Higa S, Harrington A, Parikh M. Treatment patterns, health care resource utilization, and costs associated with use of atypical antipsychotics as first vs subsequent adjunctive treatment in major depressive disorder. J Manag Care Spec Pharm 2023; 29:896-906. [PMID: 37523314 PMCID: PMC10397325 DOI: 10.18553/jmcp.2023.29.8.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND: Major depressive disorder (MDD) is a highly prevalent mental health condition associated with substantial economic burden. Inadequate response to first-line antidepressant monotherapy is common, with most patients requiring 1 or more changes in their treatment regimen. Adjunctive treatment with atypical antipsychotics (AAs) is a guideline-recommended treatment option in patients with inadequate response. However, patients often cycle through multiple treatments before receiving adjunctive AAs, and the economic impact of this delay is unknown. OBJECTIVE: To describe adjunctive treatment patterns among patients with MDD and compare health care resource utilization (HCRU) and costs between patients whose first adjunctive therapy included an AA and those who received an AA after other adjunctive treatments. METHODS: The Merative MarketScan Commercial Database (January 1, 2014, to June 30, 2019) was used to identify patients with administrative claims meeting the following inclusion criteria: adults with newly diagnosed MDD (first observed MDD diagnosis = index diagnosis date); continuous health insurance for at least 6 months pre-index and at least 3 months post-index; and initiation of MDD treatment within 60 days post-index. Lines of therapy (LOTs), HCRU, and costs were analyzed in patients who received AA adjunctive therapy, including those who initiated AAs as the first adjunctive treatment and those who initiated AAs as subsequent adjunctive treatment. RESULTS: Of 508,830 patients meeting inclusion criteria, 121,060 (24%) received adjunctive treatment and 20,797 (4%) received an AA as adjunctive therapy. Mean time to adjunctive therapy initiation was approximately 7.3 months for AA adjunctive therapy. Patients who initiated an AA as their first adjunctive therapy compared with patients who initiated an AA as their subsequent adjunctive therapy had fewer LOTs on average (0.9 LOTs vs 3.9 LOTs) and shorter time between index diagnosis date and initiation of an AA (5 months vs 12 months). Subsequent AA initiators had significantly greater HCRU than first AA initiators (driven primarily by outpatient visits) and incurred significantly higher total health care costs, with mean all-cause and mental health-related health care cost differences per patient per year of $2,441 and $1,762, respectively (both P < 0.05). CONCLUSIONS: Less than 5% of patients in this study received an adjunctive AA as part of their MDD treatment regimen, suggesting underutilization of this recommended therapeutic approach. Patients who received an AA as their first adjunctive treatment regimen had lower HCRU and health care costs than subsequent AA initiators. Along with published evidence of clinical benefits, this potential impact on economic burden should be considered when making treatment choices for patients with inadequate response to antidepressants.
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Affiliation(s)
- Rakesh Jain
- Texas Tech University School of Medicine, Austin
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6
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Kutchma ML, Perez J, Stranges E, Steele K, Garis T, Prost A, Siddiqui S, Choo-Kang C, Shaul B, Benissan DGG, Smith-Haney G, Mora N, Watson M, Griffith T, Booker N, Harrington A, Mitchell LK, Blair A, Luke A, Silva A. Filling the gaps: A community case study in using an interprofessional approach and community-academic partnerships to address COVID-19-related inequities. Front Public Health 2023; 11:1208895. [PMID: 37546307 PMCID: PMC10399686 DOI: 10.3389/fpubh.2023.1208895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Public health challenges rapidly escalated during the COVID-19 pandemic. In response to a severe lack of resources and support in the near western suburbs of Chicago, the COVID Equity Response Collaborative: Loyola (CERCL) was established by an interprofessional team of Loyola University Chicago students, staff, and faculty. CERCL sought to minimize the negative impact of COVID-19 on vulnerable communities, those that are largely Black, Hispanic, or low-income. From April 2020 to the present, the collaborative utilized community-academic partnerships and interdisciplinary collaborations to conduct programming. CERCL's programming included free community-based testing, screening for and assistance with social determinants of health, dissemination of relevant and reliable COVID-related information, provision of personal protective equipment, and facilitation of access to vaccines. With partners, the collaborative conducted 1,500 COVID-19 tests, trained 80 individuals in contact tracing, provided over 100 individuals with specifically tailored resources to address social and legal needs, distributed 5,000 resource bags, held 20 community conversations, canvassed 3,735 homes, and hosted 19 vaccine clinics. Community-academic partnerships with the health system, community and governmental agencies, and the local public health department have been critical to CERCL efforts. The interdisciplinary and interprofessional successes demonstrated in this case study lends the example of a relevant, sustainable, and practical intervention to address nuanced public health issues.
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Affiliation(s)
- Marisa L. Kutchma
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Julianna Perez
- School of Social Work, Loyola University Chicago, Chicago, IL, United States
- Health Justice Project, Loyola University Chicago, Chicago, IL, United States
| | - Elizabeth Stranges
- Loyola University Medical Center, Maywood, IL, United States
- Internal Medicine, Chinle Comprehensive Health Center, Indian Health Service, Chinle, AZ, United States
| | - Kellie Steele
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Tayler Garis
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
- Health Justice Project, Loyola University Chicago, Chicago, IL, United States
| | - Anastazia Prost
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Sumbul Siddiqui
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Candice Choo-Kang
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Bonnie Shaul
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
- AbbVie, Chicago, IL, United States
| | | | - Gwendylon Smith-Haney
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Nallely Mora
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Maya Watson
- Health Justice Project, Loyola University Chicago, Chicago, IL, United States
- School of Law, Loyola University Chicago, Chicago, IL, United States
- Law School, Wayne State University, Detroit, MI, United States
| | - Thao Griffith
- Loyola University Health System, Loyola University Chicago, Department of Pathology and Laboratory Medicine, Maywood, IL, United States
| | | | - Amanda Harrington
- Loyola University Health System, Loyola University Chicago, Department of Pathology and Laboratory Medicine, Maywood, IL, United States
| | - L. Kate Mitchell
- Health Justice Project, Loyola University Chicago, Chicago, IL, United States
- School of Law, Loyola University Chicago, Chicago, IL, United States
| | - Amy Blair
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
- Loyola University Medical Center, Maywood, IL, United States
| | - Amy Luke
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Abigail Silva
- Parkinson School of Public Health and Health Sciences, Loyola University Chicago, Maywood, IL, United States
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7
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Rhoads DD, Pournaras S, Leber A, Balada-Llasat JM, Harrington A, Sambri V, She R, Berry GJ, Daly J, Good C, Tarpatzi A, Everhart K, Henry T, McKinley K, Zannoli S, Pak P, Zhang F, Barr R, Holmberg K, Kensinger B, Lu DY. Multicenter Evaluation of the BIOFIRE Blood Culture Identification 2 Panel for Detection of Bacteria, Yeasts, and Antimicrobial Resistance Genes in Positive Blood Culture Samples. J Clin Microbiol 2023:e0189122. [PMID: 37227281 DOI: 10.1128/jcm.01891-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Diagnostic tools that can rapidly identify and characterize microbes growing in blood cultures are important components of clinical microbiology practice because they help to provide timely information that can be used to optimize patient management. This publication describes the bioMérieux BIOFIRE Blood Culture Identification 2 (BCID2) Panel clinical study that was submitted to the U.S. Food & Drug Administration. Results obtained with the BIOFIRE BCID2 Panel were compared to standard-of-care (SoC) results, sequencing results, PCR results, and reference laboratory antimicrobial susceptibility testing results to evaluate the accuracy of its performance. Results for 1,093 retrospectively and prospectively collected positive blood culture samples were initially enrolled, and 1,074 samples met the study criteria and were included in the final analyses. The BIOFIRE BCID2 Panel demonstrated an overall sensitivity of 98.9% (1,712/1,731) and an overall specificity of 99.6% (33,592/33,711) for Gram-positive bacteria, Gram-negative bacteria and yeast targets which the panel is designed to detect. One hundred eighteen off-panel organisms, which the BIOFIRE BCID2 Panel is not designed to detect, were identified by SoC in 10.6% (114/1,074) of samples. The BIOFIRE BCID2 Panel also demonstrated an overall positive percent agreement (PPA) of 97.9% (325/332) and an overall negative percent agreement (NPA) of 99.9% (2,465/2,767) for antimicrobial resistance determinants which the panel is designed to detect. The presence or absence of resistance markers in Enterobacterales correlated closely with phenotypic susceptibility and resistance. We conclude that the BIOFIRE BCID2 Panel produced accurate results in this clinical trial.
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Affiliation(s)
- Daniel D Rhoads
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Spyros Pournaras
- Laboratory of Clinical Microbiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Amy Leber
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | | | - Vittorio Sambri
- The Greater Romagna Area Hub Laboratory, Cesena, Italy
- DIMES, University of Bologna, Bologna, Italy
| | - Rosemary She
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | | | - Judy Daly
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Caryn Good
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Aikaterini Tarpatzi
- Laboratory of Clinical Microbiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Tai Henry
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | - Pil Pak
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Fan Zhang
- Northwell Health Laboratories, Lake Success, New York, USA
| | - Rebecca Barr
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | | | | | - Daisy Y Lu
- bioMérieux, Inc., Salt Lake City, Utah, USA
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8
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McIntyre RS, Higa S, Doan QV, Amari DT, Mercer D, Gillard P, Harrington A. Place of care and costs associated with acute episodes and remission in schizophrenia. J Manag Care Spec Pharm 2023; 29:499-508. [PMID: 37121252 PMCID: PMC10387981 DOI: 10.18553/jmcp.2023.29.5.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND: Schizophrenia imposes significant economic burden on patients, families, caregivers, and society. To our knowledge, place of care and associated costs of acute schizophrenia episodes have not been well characterized. OBJECTIVE: To describe the care settings and costs associated with likely acute episodes and untreated remission periods among patients with schizophrenia. METHODS: Adults with schizophrenia were identified using the IBM MarketScan Commercial and Medicare Supplemental databases (2009-2018); claims for capitated benefits plans were excluded. Acute episode index date was defined as at least 1 inpatient schizophrenia claim or outpatient schizophrenia claim (frequency of claim dependent on visit type, such as hospitalization, emergency department, private practice, clinic, urgent care, or laboratory). Mental health-related medical costs (health plan+patient) associated with acute episodes were collected over a 2-month follow-up period and stratified by setting (inpatient vs outpatient); acute episode data were reported in subgroups of patients without or with prior clozapine use, as an indication of disease severity. Remission index date was defined as at least 1 outpatient claim with a schizophrenia diagnosis with no acute episode and no oral or injectable antipsychotic therapy. Remission costs were assessed over a 3-month period. All data were analyzed descriptively. RESULTS: A total of 14,824 patients with schizophrenia met criteria for an acute episode (12,896 [87.0%] without prior clozapine use; 1,427 [9.6%] with prior clozapine use). Most acute episodes were treated in an outpatient setting (all patients, 76.3%; without prior clozapine use, 74.5%; with prior clozapine use, 87.1%). When treated inpatient, mean (SD) episode medical costs were $17,045 ($28,101) for all patients, $16,060 ($22,786) for those without prior clozapine use, and $22,827 ($55,860) for those with prior clozapine use. When treated outpatient, mean (SD) medical costs for acute episodes were $2,478 ($6,961) for all patients, $2,609 ($7,068) for those without prior clozapine use, and $1,770 ($6,560) for those with prior clozapine use. For all patients with acute episodes, regardless of clozapine use, patient-incurred out-of-pocket costs were approximately 30% of total medical costs. For an untreated period of remission, 6,950 patients with schizophrenia met criteria. Total medical costs were $2,399 for these patients over a 3-month period. CONCLUSIONS: The majority of acute schizophrenia episodes were treated in the outpatient setting. For episodes that required inpatient care, inpatient episodes were approximately 7 times more costly than episodes treated in outpatient-only settings. For acute episodes and remission periods, health plans covered most costs; however, there were additional patient-incurred out-of-pocket costs. DISCLOSURES: All authors met the International Committee of Medical Journal Editors authorship criteria. Neither honoraria nor payments were made for authorship. Dr McIntyre has received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Alkermes, Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Viatris, AbbVie, Atai Life Sciences. Dr McIntyre is a CEO of Braxia Scientific Corp. Mr Doan, Dr Amari, and Mr Mercer are employees of Genesis Research, which was funded to perform the study. Ms Higa, Dr Gillard, and Dr Harrington were employees of AbbVie at the time of the study and may hold stock. This study was sponsored by AbbVie.
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Thase ME, Stahl SM, McIntyre RS, Matthews-Hayes T, Rolin D, Patel M, Harrington A, Maletic V, Jackson WC, Vieta E. Screening for Bipolar I Disorder and the Rapid Mood Screener: Results of a Nationwide Health Care Provider Survey. Prim Care Companion CNS Disord 2023; 25. [PMID: 37115145 DOI: 10.4088/pcc.22m03322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Objective: Effective screening for bipolar I disorder can lead to enhanced assessment, improved diagnosis, and better patient outcomes. The Rapid Mood Screener (RMS), a new bipolar I disorder screening tool, was evaluated in a nationwide survey of health care providers (HCPs). Methods: Eligible HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the Mood Disorder Questionnaire (MDQ). Results were stratified by primary care and psychiatric specialty. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence level. Results: Among respondents (N = 200), 82% used a tool to screen for major depressive disorder (MDD), while 32% used a tool for bipolar disorder. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. According to HCPs, the RMS was significantly better than the MDQ on all screening tool attributes (eg, sensitivity/specificity, brevity, practicality, easy scoring; P < .05 for all). Significantly more HCPs reported that they would use the RMS versus the MDQ (81% vs 19%, P < .05); 76% reported that they would screen new patients with depressive symptoms, and 68% indicated they would rescreen patients with a depression diagnosis. Most HCPs (84%) said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder. Discussion: In our survey, the RMS was favorably evaluated by HCPs. A large percentage of respondents preferred the RMS over the MDQ and indicated that it would likely have a positive impact on clinicians' screening behavior.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Corresponding author: Michael E. Thase, MD, Department of Psychiatry, Mood and Anxiety Disorders Treatment and Research Program, 3535 Market St, Ste 670, Philadelphia, PA 19104-3309
| | - Stephen M Stahl
- Department of Psychiatry and Neuroscience, University of California Riverside School of Medicine, California
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Donna Rolin
- School of Nursing, the University of Texas at Austin, School of Nursing, Austin, Texas
| | - Mehul Patel
- AbbVie, North Chicago, Illinois (at the time of the study)
| | | | - Vladimir Maletic
- Department of Psychiatry/Behavioral Science, University of South Carolina School of Medicine, Greenville, South Carolina
| | - W Clay Jackson
- Department of Family Medicine and Department of Psychiatry, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Eduard Vieta
- University of Barcelona, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Adams J, Santarossa M, Harrington A, Bauer M, Wozniak A, Labuszewski L, Albarillo FS. In vitro susceptibility of carbapenem resistant Enterobacterales to meropenem-vaborbactam and ceftazidime-avibactam at a single academic medical centre. Infect Dis (Lond) 2023; 55:282-291. [PMID: 36772806 DOI: 10.1080/23744235.2023.2177337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales (CRE) are considered an urgent threat. Ceftazidime-avibactam and meropenem-vaborbactam contain β-lactamase inhibitors active against CRE isolates including those that produce Klebsiella pneumoniae carbapenemases (KPC). METHODS Retrospective chart review of CRE isolates from 1 January 2016 to 1 November 2018. Collected data includes a descriptive overview of measured MIC values, resistance mechanism via a polymerase chain reaction test (Xpert Carba-R, Cepheid, Sunnyvale CA), as well as clinical outcomes. RESULTS Of 106 isolates reviewed, 86 isolates met the inclusion criteria from 85 individual subjects. The breakpoint:MIC ratio for ceftazidime-avibactam overall was 4, while for meropenem-vaborbactam this ratio was 32 (p < 0.0001). For KPC isolates, ceftazidime-avibactam MIC50/MIC90 in 2016, 2017, and 2018 were 2/4 mg/L (n = 32), 2/4 mg/L (n = 17), and 2/8 mg/L (n = 30), respectively. The meropenem-vaborbactam MIC50/MIC90, for KPC isolates in 2016, 2017, and 2018 were 0.06/0.125 mg/L (n = 32), 0.06/0.1 mg/L (n = 17), and 0.06/0.5 mg/L (n = 30), respectively. Microbiologic cure was 75% (n = 16) in ceftazidime-avibactam subjects and 58.3% (n = 12) in subjects treated with alternative agents (p = 0.43). The 14- and 30-day mortality was numerically higher in subjects treated with alternate agents when compared ceftazidime-avibactam 2/9 (22.2%) vs 3/17 (17.6%) (p = 1.00) and 4/9 (44.4%) vs 4/17 (28.6%) (p = 0.38), respectively. For ceftazidime-avibactam, 30-day mortality in 2016, 2017, and 2018 was 0/5 (0%), 0/2 (0%), and 4/10 (40%). CONCLUSION Selective pressure from the use of ceftazidime-avibactam at our institution may be decreasing its utility as a first-line agent for CRE infections. Meropenem-vaborbactam maintained low MIC values and may be a promising treatment option for CRE.
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Affiliation(s)
- Jenna Adams
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Maressa Santarossa
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
- Department of Medicine, Division of Infectious Diseases, Loyola University Medical Center, Maywood, IL, USA
| | - Amanda Harrington
- Department of Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Michael Bauer
- Department of Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Amy Wozniak
- Clinical Research Office, Loyola University of Chicago, Chicago, IL, USA
| | - Laurie Labuszewski
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Fritzie S Albarillo
- Department of Medicine, Division of Infectious Diseases, Loyola University Medical Center, Maywood, IL, USA
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Manuel C, Maynard R, Abbott A, Adams K, Alby K, Sweeney A, Dien Bard J, Flores II, Rekasius V, Harrington A, Kidd TS, Mathers AJ, Tekle T, Simner PJ, Humphries RM. Evaluation of Piperacillin-Tazobactam Testing against Enterobacterales by the Phoenix, MicroScan, and Vitek2 Tests Using Updated Clinical and Laboratory Standards Institute Breakpoints. J Clin Microbiol 2023; 61:e0161722. [PMID: 36719243 PMCID: PMC9945575 DOI: 10.1128/jcm.01617-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/24/2022] [Indexed: 02/01/2023] Open
Abstract
In 2022, the Clinical and Laboratory Standards Institute (CLSI) updated piperacillin-tazobactam (TZP) breakpoints for Enterobacterales, based on substantial data suggesting that historical breakpoints did not predict treatment outcomes for TZP. The U.S. Food and Drug Administration (FDA) has not yet adopted these breakpoints, meaning commercial manufacturers of antimicrobial susceptibility testing devices cannot obtain FDA clearance for the revised breakpoints. We evaluated the Phoenix (BD, Sparks, MD), MicroScan (Beckman Coulter, Sacramento, CA), and Vitek2 (bioMérieux, Durham, NC) TZP MICs compared to reference broth microdilution for a collection of 284 Enterobacterales isolates. Phoenix (n = 167 isolates) demonstrated 84.4% categorical agreement (CA), with 4.2% very major errors (VMEs) and 1.8% major errors (MEs) by CLSI breakpoints. In contrast, CA was 85.0% with 4.3% VMEs and 0.8% MEs for the Phoenix with FDA breakpoints. MicroScan (n = 55 isolates) demonstrated 80.0% CA, 36.4% VMEs, and 4.8% MEs by CLSI breakpoints and 81.8% CA, 44.4% VMEs, and 0.0% MEs by FDA breakpoints. Vitek2 (n = 62 isolates) demonstrated 95.2% CA, 6.3% VMEs, and 0.0% MEs by CLSI and 96.8% CA, 0.0% VMEs, and 2.2% MEs by FDA breakpoints. Overall, the performance of the test systems was not substantially different using CLSI breakpoints off-label than using on-label FDA breakpoints. However, limitations were noted with higher-than-desired VME rates (all three systems) and lower-than-desired CA (MicroScan and Phoenix). Laboratories should consider adoption of the revised CLSI breakpoints with automated test systems but be aware that some performance challenges exist for testing TZP on automated systems, regardless of breakpoints applied.
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Affiliation(s)
- Carmila Manuel
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard Maynard
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - April Abbott
- Laboratory Medicine, Microbiology and Molecular Diagnostics, Deaconess Health System, Evansville, Indiana, USA
| | - Kara Adams
- Laboratory Medicine, Microbiology and Molecular Diagnostics, Deaconess Health System, Evansville, Indiana, USA
| | - Kevin Alby
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Clinical Microbiology Laboratory, McLendon Clinical Laboratories, UNC Medical Center, Chapel Hill, North Carolina, USA
| | - Amy Sweeney
- Clinical Microbiology Laboratory, McLendon Clinical Laboratories, UNC Medical Center, Chapel Hill, North Carolina, USA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Irvin Ibarra Flores
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Violet Rekasius
- Department of Pathology and Laboratory Medicine, Loyola University, Chicago, Illinois, USA
| | - Amanda Harrington
- Department of Pathology and Laboratory Medicine, Loyola University, Chicago, Illinois, USA
| | - Tiffany S. Kidd
- Clinical Microbiology Laboratory, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Amy J. Mathers
- Clinical Microbiology Laboratory, University of Virginia Medical Center, Charlottesville, Virginia, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Tsigereda Tekle
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patricia J. Simner
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Romney M. Humphries
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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McIntyre RS, Bloudek L, Timmons JY, Gillard P, Harrington A. Total healthcare cost savings through improved bipolar I disorder identification using the Rapid Mood Screener in patients diagnosed with major depressive disorder. Curr Med Res Opin 2023; 39:605-611. [PMID: 36776128 DOI: 10.1080/03007995.2023.2177413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION Misdiagnosis of bipolar I disorder (BP-I) as major depressive disorder (MDD) leads to increased healthcare resource utilization and costs. The cost-effectiveness of the Rapid Mood Screener (RMS), a tool to identify BP-I in patients with depressive symptoms, was assessed in patients diagnosed with MDD presenting with depressive episodes. METHODS A decision-tree model of a hypothetical cohort of 1000 patients in a US health plan was used to estimate the number of correct diagnoses and overall total, direct healthcare costs over a 3-year timeframe for RMS-screened versus unscreened patients. Model inputs included the prevalence of BP-I in patients diagnosed with MDD, RMS sensitivity/specificity, and the cost of misdiagnosing BP-I as MDD. RESULTS Screening with the RMS resulted in 171, 159, and 143 additional correct BP-I or MDD diagnoses at Years 1, 2, and 3, respectively. Total healthcare plan cost savings were $1279 per patient in Year 1. Cumulative cost savings per patient for RMS screening versus no RMS screening were $2307 over 2 years and $3011 over 3 years. Scenario analyses showed that the RMS would remain cost-saving assuming a lower prevalence of BP-I (20% or 10%) versus the base case (24.3%). CONCLUSION The RMS is a cost-effective tool to identify BP-I in patients who would otherwise be misdiagnosed with MDD. Screening with the RMS resulted in cost-savings over 3 years, with model results remaining robust even with lower prevalence of BP-I and reduced RMS sensitivity assumptions.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada
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13
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Garner O, Harrington A, DesJarlais S, Traczewski M, Beasley D, Diaz J, Brookman R, Lockett Z, Chau J. 342. Multicenter Evaluation of Fosfomycin MIC Results for Enterobacterales Using EUCAST V11 Breakpoints (i.v. and oral for uncomplicated UTI only, E. coli) on MicroScan Dried Gram Negative MIC Panels. Open Forum Infect Dis 2022. [PMCID: PMC9751927 DOI: 10.1093/ofid/ofac492.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background EUCAST V11 fosfomycin breakpoints for Enterobacterales (i.v. and oral for uncomplicated UTI only, E. coli) were evaluated against data from a multicenter clinical study on a MicroScan Dried Gram Negative MIC (MSDGN) Panel. MIC results were compared to results obtained with agar dilution reference prepared according to CLSI methodology. Methods A total of 344 Gram negative clinical isolates including 191 Enterobacterales were tested using the turbidity and Prompt® methods of inoculation during the efficacy phase at three clinical sites. An evaluation was conducted by comparing MIC values obtained using the MSDGN panels to MICs utilizing the CLSI agar dilution reference. MSDGN panels were incubated at 35 ± 1°C and read on the WalkAway System, the autoSCAN-4 instrument, and read visually at 16-20 hours. Agar dilution plates were prepared according to CLSI methodology, incubated for 16-20 hours and read visually. EUCAST v11.0 fosfomycin breakpoints (mg/L) used for interpretation of MIC results were: i.v. for Enterobacterales ≤ 32 S, > 32 R and oral for uncomplicated UTI only, E. coli ≤ 8 S, > 8 R. Results Essential agreement, categorical agreement and categorical errors were calculated compared to MIC results from agar dilution plates. Results for all efficacy isolates with turbidity inoculation and manual read are found in Table 1.
- Results ![]() Conclusion This multicenter study showed that fosfomycin MIC results for i.v. for Enterobacterales and E. coli (oral, for uncomplicated UTI only) obtained with the MSDGN panel correlate well with MICs obtained using CLSI agar dilution reference using EUCAST interpretive criteria. © 2022 Beckman Coulter. All rights reserved. All other trademarks are the property of their respective owners. Beckman Coulter, the stylized logo, and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries. Disclosures Omai Garner, PhD, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc. Amanda Harrington, PhD, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc.|bioMeriuex/BioFire: Grant/Research Support Sharon DesJarlais, BS, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc. Maria Traczewski, BS, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc. Denise Beasley, BS, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc. Jose Diaz, BS, Beckman Coulter, Inc.: Employee of Beckman Coulter Regina Brookman, BS, Beckman Coulter, Inc.: Employee of Beckman Coulter Zabrina Lockett, PhD, Beckman Coulter, Inc.: Employee of Beckman Coulter Jennifer Chau, PhD, Beckman Coulter, Inc.: Employee of Beckman Coulter.
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Affiliation(s)
- Omai Garner
- University of California Los Angeles, Los Angeles, California
| | | | | | | | | | - Jose Diaz
- Beckman Coulter, Inc., West Sacramento, CA, California
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14
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Kim DY, Cheknis AK, Serna-Perez F, Lin MY, Hayden MK, Moore NM, Harrington A, Tesic V, Beavis KG, Gerding DN, Johnson S, Skinner AM. 403. Strain Epidemiology of Clostridioides difficile across Three Geographically Distinct Medical Centers in Chicago. Open Forum Infect Dis 2022. [PMCID: PMC9752158 DOI: 10.1093/ofid/ofac492.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Clostridioides difficile infections (CDI) are caused by a large and diverse group of strains with differences in prevalence and associated morbidity. Over the past 20 years the C. difficile (CD) molecular epidemiology has changed as the prevalence of the epidemic strain recognized as restriction endonuclease analysis (REA) group BI or PCR-Ribotype group (RT) 027 has decreased. The objective of this study was to determine the current epidemiology of CD in the city of Chicago. Methods Baseline characteristics and symptoms were compared for 81 patients who tested positive for CD by PCR (tcdB) between 9/1/2021 and 10/7/2021 at 3 hospitals in the city of Chicago. Patients were classified as having healthcare-associated CDI (HA-CDI) if symptoms began >72 hours after hospital admission, community-associated CDI (CA-CDI) if symptoms began ≤72 hours prior to admission, and community-onset healthcare-associated CDI (COHA-CDI) if they had been hospitalized ≤4 weeks prior to CDI diagnosis. Available stools were cultured and recovered CD isolates underwent REA typing. Determination of CD colonization was made by review of symptoms including chronicity of symptoms, stool frequency, and response to treatment. Results Among all patients, 33% (27/81) were CA-CDI, 28% (23/81) COHA-CDI, 11% (9/81) HA-CDI, and 27% (22/81) were classified as colonized. Primary CDI accounted for 66% (39/59) of the infections. Among patients with a primary CDI, 46% (18/39) of patients were classified as CA-CDI whereas COHA-CDI and HA-CDI accounted for 54% (21/39) of infections. REA group Y was the most common group strain accounting for 29% (22/75) of isolates. (Figure 1) REA group Y accounted for 26% (7/27) of CA-CDI compared to 0 REA group BI [p=0.06], and REA group Y accounted for 35% (7/20) of all colonized patients. (Figure 2)
![]() ![]() Conclusion There has been a marked change in the CD epidemiology within the city of Chicago since 2009 when REA group BI accounted for 61% of CDI (Black et al ICHE 2011; 32:897-902). REA group Y (typically identified as RT 014/020) is now the most common group strain in Chicago supplanting REA group BI (RT027). REA group Y appears to be associated primarily with CA-CDI and CD colonization. A detailed genomic analysis of REA group Y is required to determine potential reservoirs of REA group Y. Disclosures Mary K. Hayden, MD, Sanofi: Member, clinical adjudication panel Nicholas M. Moore, PhD, D(ABMM), Abbott Molecular: Grant/Research Support|Cepheid: Grant/Research Support Amanda Harrington, PhD, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc.|bioMeriuex/BioFire: Grant/Research Support Dale N. Gerding, MD, Destiny Pharma plc.: Advisor/Consultant Stuart Johnson, M.D., Ferring Pharmaceuticals: Membership on Ferring Publication Steering Committee|Ferring Pharmaceuticals: Employee|Summit Plc: Advisor/Consultant.
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Affiliation(s)
| | | | | | | | | | | | | | - Vera Tesic
- University of Chicago, Department of Pathology, Chicago, Illinois
| | | | - Dale N Gerding
- Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Stuart Johnson
- Hines VA Hospital and Loyola University Medical Center, Hines, Illinois
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15
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McIntyre RS, Laliberté F, Germain G, MacKnight SD, Gillard P, Harrington A. The real-world health resource use and costs of misdiagnosing bipolar I disorder. J Affect Disord 2022; 316:26-33. [PMID: 35952932 DOI: 10.1016/j.jad.2022.07.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Misdiagnosis of bipolar I disorder (BP-I) as major depressive disorder (MDD) is common. This study evaluated healthcare resource utilization (HRU) and costs among BP-I patients who were initially misdiagnosed with MDD (misdiagnosed BP-I cohort) versus patients diagnosed with BP-I without a known prior MDD diagnosis (BP-I only cohort). METHODS Data from IBM® MarketScan® Research Databases were used. The index date was the first MDD diagnosis for misdiagnosed patients or first BP-I diagnosis for BP-I only patients. Inverse probability of treatment weighting was used to balance baseline characteristics between cohorts. All-cause and mental health (MH)-related HRU and costs were compared between weighted cohorts using rate ratios (RRs) and mean cost differences, respectively. Outcomes were reported per patient-year (PPY). Confidence intervals and P-values were calculated using non-parametric bootstrap procedures. RESULTS Overall, 14,729 misdiagnosed BP-I and 16,072 BP-I only patients met criteria. Baseline characteristics were balanced across weighted cohorts. Misdiagnosed BP-I patients had significantly higher rates of hospitalizations, emergency room visits, and outpatient visits than BP-I only patients during follow-up (all-cause RRs: 1.94, 1.33, and 1.38, respectively, all P < .001; MH-related RRs: 2.19, 1.77, and 1.77, respectively, all P < .001). Similarly, misdiagnosed BP-I patients incurred significantly higher total healthcare costs PPY over follow-up (all-cause: $21,202 vs $14,661, cost difference = $6541; MH-related: $12,901 vs $6749, cost difference = $6152; both P < .001). Cost differences were even higher during the first year (all-cause = $7146; MH-related = $6619; both P < .001). LIMITATIONS Claims database (e.g., coding inaccuracies); generalizability to uninsured patients. CONCLUSIONS The prompt and correct diagnosis of BP-I may significantly reduce HRU and costs.
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16
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Eisenstein EL, Sapp S, Harding T, Harrington A, Velazquez EJ, Mentz RJ, Greene SJ, Sachdev V, Kim DY, Anstrom KJ. Ascertaining Death Events in a Pragmatic Clinical Trial: Insights From the TRANSFORM-HF Trial. J Card Fail 2022; 28:1563-1567. [PMID: 35181553 PMCID: PMC9378754 DOI: 10.1016/j.cardfail.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Death ascertainment can be challenging for pragmatic clinical trials that limit site follow-up activities to usual clinical care. METHODS AND RESULTS We used blinded aggregate data from the ongoing ToRsemide comparison with furoSemide FOR Management of Heart Failure (TRANSFORM-HF) pragmatic clinical trial in patients with heart failure to evaluate the agreement between centralized call center death event identification and the United States National Death Index (NDI). Of 2284 total patients randomized through April 12, 2021, 1480 were randomized in 2018-2019 and 804 in 2020-2021. The call center identified 416 total death events (177 in 2018-2019 and 239 in 2020-2021). The NDI 2018-2019 final file identified 178 death events, 165 of which were also identified by the call center. The study's inter-rater reliability metric (Cohen's kappa coefficient, 0.920; 95% confidence interval, 0.889-0.951) demonstrates a high level of agreement. The time between a death event and its identification was less for the call center (median, 47 days; interquartile range, 11-103 days) than for the NDI (median, 270 days; interquartile range, 186-391 days). CONCLUSIONS There is substantial agreement between deaths identified by a centralized call center and the NDI. However, the time between a death event and its identification is significantly less for the call center.
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Affiliation(s)
| | - Shelly Sapp
- Duke Clinical Research Institute, Durham, North Carolina
| | - Tina Harding
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Eric J Velazquez
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Vandana Sachdev
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Dong-Yun Kim
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland
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Jain R, Kong AM, Gillard P, Harrington A. Treatment Patterns Among Patients with Bipolar Disorder in the United States: A Retrospective Claims Database Analysis. Adv Ther 2022; 39:2578-2595. [PMID: 35381965 PMCID: PMC9123057 DOI: 10.1007/s12325-022-02112-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/03/2022] [Indexed: 12/27/2022]
Abstract
Introduction Bipolar disorder is a chronic and complex disorder that can be difficult to treat. The objective of this retrospective study was to describe treatment patterns among patients with bipolar disorder. Methods Adults newly diagnosed with bipolar disorder from 2016 to 2018 were identified using the IBM® MarketScan® Commercial claims database. Patients were enrolled for at least 12 months prior to and 6 months after initial diagnosis. Lines of therapy (LOTs) were continuous treatment periods based on filled prescriptions; medications, such as antidepressants, mood stabilizers, atypical antipsychotics, benzodiazepines, stimulants, and off-label prescriptions, were recorded. All data were analyzed descriptively. Results A total of 40,345 patients met criteria. The most common initial episode types were bipolar II (38.1%), and bipolar I depression (29.8%), mania (12.8%), and mixed features (12.0%). Among all episode types, approximately 90% of patients received treatment (LOT1) and approximately 80% of these patients received at least one additional LOT. Across all episode types, the most common medication classes in LOT1 (n = 36,587) were mood stabilizers (43.8%), antidepressants (42.3%; 12.9% as monotherapy), atypical antipsychotics (31.7%), and benzodiazepines (20.7%); with subsequent LOTs, antidepressant (51.4–53.8%) and benzodiazepine (26.9–27.4%) usage increased. Also in LOT1, there were 2067 different regimens. Treatment patterns were generally similar across episode type. Conclusions Antidepressants and benzodiazepines were frequently prescribed to treat bipolar disorder despite guidelines recommending against use as frontline therapy. These results highlight the considerable heterogeneity in care and suggest that many clinicians treating bipolar disorder are not using evidence-based prescribing practices. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02112-6.
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Affiliation(s)
- Rakesh Jain
- Texas Tech University School of Medicine-Permian Basin, Midland, TX, USA
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18
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McIntyre RS, Higa S, Doan QV, Amari D, Oliveri D, Gillard P, Harrington A. Place of care and costs associated with acute episodes and remission in bipolar I disorder. J Med Econ 2022; 25:1110-1117. [PMID: 36082506 DOI: 10.1080/13696998.2022.2120264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS To our knowledge, literature describing the place of care and associated costs during acute bipolar I disorder (BP-I) episodes is limited. We conducted a claims-based retrospective study to address this gap. MATERIALS AND METHODS Adults with BP-I were identified via IBM MarketScan Commercial and Medicare Supplemental databases. The acute episode index date was defined by ≥1 inpatient BP-I claim(s) or ≥1 outpatient or ≥3 outpatient BP-I claims (depending on visit type) in a 2-week (manic/mixed) or 4-week (depressive) period. Likely acute episodes were defined as 3- and 6-week periods for manic/mixed and depressive episodes, respectively; total mental health-related medical costs (health plan + patient) were collected during these intervals and stratified by setting (inpatient versus outpatient). Initial and subsequent episodes were captured; data were reported in subgroups without and with clozapine use, a proxy for disease severity. The remission index date was the earliest outpatient claim with a bipolar remission diagnosis with no acute episode or treatment. Remission costs were collected over a 3-month period. All results were analyzed descriptively. RESULTS A total of 41,516 patients with 130,221 acute manic/mixed episodes and 47,763 patients with 149,207 acute depressive episodes met the study criteria. Over 84% of acute episodes were treated in outpatient settings. Mental health-related medical costs for manic/mixed episodes were $15,444 for inpatient and $1,577 for outpatient settings; inpatient and outpatient costs for depressive episodes were $17,376 and $2,154, respectively. Health plans covered approximately 78% of medical costs for both episode types with and without prior clozapine use. A total of 8,143 patients met remission criteria; the total 3-month outpatient costs were $1,225. CONCLUSIONS Most BP-I acute manic/mixed or depressive episodes were treated in the outpatient setting. Episodes with inpatient care were 8-10 times more costly than outpatient-only episodes. Health plans covered most medical costs, but additional patient-incurred out-of-pocket costs remained.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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19
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Iqbal H, Harrington A, Kroft SH. The Pathologic Spectrum of Bone Marrow Involvement by Double- and Triple-hit Lymphomas. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements (double- and triple-hit lymphomas, DHL/THL) are a distinct entity due to shared biology and aggressive behavior, exhibiting poor outcomes with standard therapies. While pathologic features of DHL/THLs in primary sites have been well described, little information is available regarding the clinicopathologic features of bone marrow involvement by this entity.
Methods/Case Report
Files were searched from 2010-2020 for all DHL/THLs. Since mid-2016, all aggressive B-cell lymphomas were reflexed to DHL/THL FISH testing. Prior to that, criteria for performing FISH varied. Clinical and laboratory data were obtained through chart review. Both BM and primary diagnostic specimens were reviewed when possible.
Results (if a Case Study enter NA)
There were 46 DHL/THL cases with initial staging BM evaluations, of which 13 (28%) were positive for DHL/THL; 11 were available for review (5F:6M; 28-95 years). All patients with positive BMs were stage 3 or 4 irrespective of the BM findings. Lymphoma cytology in positive BMs was blastoid in 6, large cell in 2, and high grade, NOS in 3. The cytology in primary tissues was not significantly associated with the rate of marrow involvement. PB smears were available for 9/11 BM(+) cases; of these, 6 (66.7%) had circulating lymphoma cells in the blood, ranging from rare to greater than 40% lymphoma cells (median, 4%). Lymphoma cells with cytoplasmic vacuoles were present in 5 cases (45%). No BM infiltrates had a starry-sky appearance. Infiltration patterns included diffuse (3), diffuse and interstitial (3), and interstitial (3). One exhibited only rare, scattered lymphoma cells in the aspirate and core biopsy, and another with large cell morphology showed random focal (nodular) and focally paratrabecular infiltration. The proliferation index in the marrow infiltrates ranged from 50% to >90% (median, 65%). Flow cytometry was positive in 9 of 10 cases; the single negative study was from an outside institution
Conclusion
Our study demonstrates 28% of DHL/THLs show BM involvement at diagnosis. Notably, the peripheral blood was involved in 2/3 of cases with marrow infiltration (13% of total cases), ranging from rare circulating cells to frank leukemic involvement. Cytologically, the marrow infiltrates were predominantly blastoid or high grade NOS. Marrow infiltrates generally displayed leukemic rather than lymphomatous patterns of involvement.
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Affiliation(s)
- H Iqbal
- Pathology, MCWAH, Wauwatosa, Wisconsin, UNITED STATES
| | - A Harrington
- Pathology, MCWAH, Wauwatosa, Wisconsin, UNITED STATES
| | - S H Kroft
- Pathology, MCWAH, Wauwatosa, Wisconsin, UNITED STATES
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20
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Francis E, Harrington A, Eschliman PJ, Harrington S, Duzan D, Tanabe P. Comparison of the Institute for Credentialing Excellence Multi-Organization Survey of Certificants. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
The Institute for Credentialing Excellence (ICE) conducted a study to measure the value that credential holders place on certification, collecting survey data from a large sample of more than 12,000 credential holders representing six organizations (4 of which were healthcare). In May of 2019, ASCP BOC sent the survey to 47,384 individuals certified within the last 5 years. Of those who received the survey; 2,038 completed the 80 required questions. A comparison of survey data provided an overview of the top five differences in the full survey data (n=9,407) and the data from respondents credentialed by ASCP BOC (n = 2,038 or 22% of full survey respondents) and highlighted the primary reasons individuals pursue certification.
Methods/Case Report
This survey sought to define certificants’ attitudes toward and experiences with certification. Survey questions were grouped by four primary subject areas:
The Value of Certification for Respondents’ Professions
The Value of Certification for Employers
The Value of Certification Outside the U.S. and Canada
The Value of Certification for Certificants
- Responses of themed queries of full survey data and BOC survey data were viewed side by side and averages, standard deviations and medians were calculated. The top 5 items indicating the highest difference from the full survey data results were highlighted.
- Ranked primary motivational factors for the pursuit of certification were viewed side-by-side.
Results (if a Case Study enter NA)
Based on a side-by-side comparison of full survey data and BOC survey data, only minor differences were noted with the exception of the question pertaining to the perceived value of recertification. Both differences and items of agreement were highlighted.
The top 10 reasons for seeking certification were the same amongst both the full survey and ASCP BOC survey respondents, with minor differences in priority order.
Conclusion
With the exception of the question regarding the value of recertification, discrepancies noted were minor. On most questions pertaining to the various benefits of certification, a majority of respondents gave a positive response about certification and its relationship to beneficial outcomes for their professions, employers, or themselves. It is clear that certificants place a high value on certification and believe that certification provides a number of valuable benefits.
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Affiliation(s)
- E Francis
- Fitchburg State, Fitchburg, Massachusetts, UNITED STATES
| | - A Harrington
- Medical College of Wisconsin, Milwaukee, Wisconsin, UNITED STATES
| | - P J Eschliman
- Western Missouri Medical Center, Overland Park, Kansas, UNITED STATES
| | - S Harrington
- Cleveland Clinic, Cleveland, Ohio, UNITED STATES
| | - D Duzan
- Providence Health & Services, Spokane, Washington, UNITED STATES
| | - P Tanabe
- J.R. Young, ASCP BOC, Chicago, Illinois, UNITED STATES
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21
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Harrington A, Kroft SH, Wells T, Gannon V. Reducing IV-contaminated blood specimens in the clinical laboratory: A Quality Improvement Project. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Preanalytical errors constitute the most common errors in the laboratory, with improper specimen collection accounting for many errors. In our laboratory, we had a sentinel event related to repeated deletions of suspected IV-contaminated draws, and herein report our quality improvement project (QIP) to reduce deleted test results and IV-contaminated specimens.
Methods/Case Report
Our QIP initiated with creating a core-lab task force. Several interventions were launched: (A) policy/definition standardization, (B) nursing IV-line/cathedar in-services, (C) in-services on deleting test results and identifying IV-contamination, (D) policy updates to reflect no deletions without evidence of IV-contamination, and (E) mitigation steps requiring supervisory approval for result deletions. We measured: patient safety events (PSRs); RECOLLECTION comment usage and efficacy (disclaimer attached to results thought to be IV-contaminated, requesting recollection); and mitigation failures. Efficacy of the comment usage was measured by comparing subsequent collections to the original and determining likelihood of IV-contamination (contaminated, not contaminated, and unsure). Prior to the QIP, lab practice was to delete suspected IV-contaminated results and those requested by the care team.
Results (if a Case Study enter NA)
PSRs attributable to IV-contamination dropped from 47/mo. (time 0) to 18/mo. over an 11-month period (min-8/mo.; max-64/mo.), with the greatest decrement seen following intervention C. The RECOLLECTION comment was attached to 38 results (0.06% of total accessions) at the start and 73 results (0.12% of total accessions) at time 11 mos. and showed greatest increase in use immediately prior to interventions C and D (approximately 3-fold increase). At time 0, 54% of RECOLLECTION comments were deemed contaminated and 31% were not; at time 11mos., 74% (50/68) were contaminated and 24% (16/68) were not. Mitigation failures numbered 5/mo. initially and 1/mo. at time 11 mos.
Conclusion
With multiple educational and supervisory interventions, we demonstrate a reduction in PSRs attributable to IV-contamination collections at our hospital. Use of cautionary disclaimers was overall minimal and appropriately used.
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Affiliation(s)
- A Harrington
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, UNITED STATES
| | - S H Kroft
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, UNITED STATES
| | - T Wells
- Froedtert Hospital, Milwaukee, Wisconsin, UNITED STATES
| | - V Gannon
- Wisconsin Diagnostic Laboratories, Milwaukee, Wisconsin, UNITED STATES
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22
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Deng X, Evdokimova M, O’Brien A, Rowe CL, Clark NM, Harrington A, Reid GE, Uprichard SL, Baker SC. Breakthrough Infections with Multiple Lineages of SARS-CoV-2 Variants Reveals Continued Risk of Severe Disease in Immunosuppressed Patients. Viruses 2021; 13:1743. [PMID: 34578324 PMCID: PMC8472867 DOI: 10.3390/v13091743] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022] Open
Abstract
The pandemic of COVID-19 caused by SARS-CoV-2 infection continues to spread around the world. Vaccines that elicit protective immunity have reduced infection and mortality, however new viral variants are arising that may evade vaccine-induced immunity or cause disease in individuals who are unable to develop robust vaccine-induced responses. Investigating the role of viral variants in causing severe disease, evading vaccine-elicited immunity, and infecting vulnerable individuals is important for developing strategies to control the pandemic. Here, we report fourteen breakthrough infections of SARS-CoV-2 in vaccinated individuals with symptoms ranging from asymptomatic/mild (6/14) to severe disease (8/14). High viral loads with a median Ct value of 19.6 were detected in the nasopharyngeal specimens from subjects regardless of disease severity. Sequence analysis revealed four distinct virus lineages, including alpha and gamma variants of concern. Immunosuppressed individuals were more likely to be hospitalized after infection (p = 0.047), however no specific variant was associated with severe disease. Our results highlight the high viral load that can occur in asymptomatic breakthrough infections and the vulnerability of immunosuppressed individuals to post-vaccination infections by diverse variants of SARS-CoV-2.
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Affiliation(s)
- Xufang Deng
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (X.D.); (M.E.); (A.O.); (C.L.R.); (S.L.U.)
| | - Monika Evdokimova
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (X.D.); (M.E.); (A.O.); (C.L.R.); (S.L.U.)
| | - Amornrat O’Brien
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (X.D.); (M.E.); (A.O.); (C.L.R.); (S.L.U.)
| | - Cynthia L. Rowe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (X.D.); (M.E.); (A.O.); (C.L.R.); (S.L.U.)
| | - Nina M. Clark
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (N.M.C.); (G.E.R.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA;
| | - Amanda Harrington
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA;
- Department of Pathology and Laboratory Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA
| | - Gail E. Reid
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (N.M.C.); (G.E.R.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA;
| | - Susan L. Uprichard
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (X.D.); (M.E.); (A.O.); (C.L.R.); (S.L.U.)
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (N.M.C.); (G.E.R.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA;
| | - Susan C. Baker
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA; (X.D.); (M.E.); (A.O.); (C.L.R.); (S.L.U.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60153, USA;
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23
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Harrington A, Malone D, Doucette W, Vaffis S, Bhattacharjee S, Chan C, Warholak T. A conceptual framework for evaluation of community pharmacy pay-for-performance programs. J Am Pharm Assoc (2003) 2021; 61:804-812. [PMID: 34413002 DOI: 10.1016/j.japh.2021.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent interest in initiating pay-for-performance (P4P) programs indicates an underlying belief that economic incentives will have a direct impact on health care quality and efficiency. Evaluations of the impact of P4P programs on health care organizations and providers have been presented in the literature; however, none have focused on the impact of an incentive targeting community pharmacies. OBJECTIVE To propose a theory-derived conceptual framework of how a financial incentive might work in a community pharmacy. METHODS Studies from the fields of economics (agency theory), psychology (intrinsic and extrinsic motivators; expectancy theory), and organizational theory (ownership, institutional layers, organizational culture, and change management; quality improvement) were reviewed to inform the framework's components. This proposed conceptual framework also integrated and expanded on previous health care-related P4P models. RESULTS P4P programs inherently use financial incentives to catalyze change; however, elements from psychology and organizational theories along with economic theory were identified as important considerations in how a financial incentive may operate when targeting a community pharmacy. Through the incorporation of these theories along with other P4P frameworks in health care, a conceptual framework was derived comprising 4 domains: incentive, pharmacy, other influencing factors, and P4P program measures. Hypothesized relationships among these domains were depicted. CONCLUSION As focus on improving the quality of health care provision develops, opportunities for pharmacists to provide patient care services beyond dispensing will continue to advance, along with expanded reimbursement mechanisms extending beyond traditional product dispensing. The proposed theory-derived conceptual framework serves to depict how the integration of P4P and other factors may affect the pharmacy environment and subsequently affect a pharmacy's capability to perform well on medication-related quality measures. This framework may be used as a foundation on which to design studies to investigate the association between community pharmacy factors and performance in a P4P program.
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24
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Thase ME, Harrington A, Calabrese J, Montgomery S, Niu X, Patel MD. Evaluation of MADRS severity thresholds in patients with bipolar depression. J Affect Disord 2021; 286:58-63. [PMID: 33677183 DOI: 10.1016/j.jad.2021.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Montgomery-Åsberg Depression Rating Scale (MADRS) is commonly used to assess depression symptom changes in clinical trials; however, the score itself can be difficult to interpret without clinical context. Categories of depression severity corresponding to MADRS total score have not been established for bipolar depression, which was the objective of this study. METHODS Data were pooled from 3 randomized, double-blind, placebo-controlled trials of cariprazine in patients with bipolar I depression; placebo and cariprazine arms were pooled. An anchor-based approach was used to map MADRS total score to the clinician-rated, 7-category Clinical Global Impression of Severity scale (CGI-S). Spearman's correlation coefficient was used to assess associations between MADRS total and CGI-S scores. Optimal MADRS severity thresholds for each CGI-S category was determined via Youden index using receiver operating characteristic (ROC) analyses. RESULTS Using data from 1523 patients with bipolar depression, mean MADRS total scores were positively correlated with mean CGI-S scores at week 6 (r = 0.87; P<.0001). Using ROC curves, MADRS severity thresholds corresponding to each CGI-S category were estimated with high sensitivity and specificity: 0-6 for "normal, not at all ill", 7-12 for "borderline mentally ill", 13-18 for "mildly ill", 19-23 for "moderately ill", 24-36 for "markedly ill", 37-39 for "severely ill", and ≥40 for "extremely ill". CONCLUSIONS Utilizing data from 3 clinical trials of patients with bipolar depression, MADRS severity thresholds were identified. These empirical findings may help clinicians contextualize MADRS results from bipolar clinical research and apply to their practice. TRIAL REGISTRATION clinicaltrials.gov NCT01396447, NCT02670538, NCT02670551.
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Affiliation(s)
| | | | - Joseph Calabrese
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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25
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McIntyre RS, Patel MD, Masand PS, Harrington A, Gillard P, McElroy SL, Sullivan K, Montano CB, Brown TM, Nelson L, Jain R. The Rapid Mood Screener (RMS): a novel and pragmatic screener for bipolar I disorder. Curr Med Res Opin 2021; 37:135-144. [PMID: 33300813 DOI: 10.1080/03007995.2020.1860358] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Depressive episodes and symptoms of bipolar I disorder are commonly misdiagnosed as major depressive disorder (MDD) in primary care. The novel and pragmatic Rapid Mood Screener (RMS) was developed to screen for manic symptoms and bipolar I disorder features (e.g. age of depression onset) to address this unmet clinical need. METHODS A targeted literature search was conducted to select concepts thought to differentiate bipolar I from MDD and screener tool items were drafted. Items were tested and refined in cognitive debriefing interviews with individuals with self-reported bipolar I or MDD (n = 12). An observational study was conducted to evaluate predictive validity. Participants with clinical interview-confirmed bipolar I or MDD diagnoses (n = 139) completed a draft 10-item screening tool and other questionnaires. Data were analyzed to identify the smallest possible subset of items with optimized sensitivity and specificity. RESULTS Adults with confirmed bipolar I (n = 67) or MDD (n = 72) participated in the observational study. Ten draft screening tool items were reduced to 6 final RMS items based on the item-level analysis. When 4 or more items of the RMS were endorsed ("yes"), sensitivity was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties were an improvement over the Mood Disorder Questionnaire in the same analysis sample while using 60% fewer items. CONCLUSION The pragmatic 6-item RMS differentiates bipolar I disorder from MDD in patients with depressive symptoms, providing real-world guidance to primary care practitioners on whether a more comprehensive assessment for bipolar I disorder is warranted.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | | | | | | | | | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kate Sullivan
- Knoxville Behavioral & Mental Health Services, Knoxville, TN, USA
| | | | | | | | - Rakesh Jain
- School of Medicine, Texas Tech University - Permian Basin, Midland, TX, USA
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Traczewski MM, Beasley D, Harrington A, DesJarlais S, Garner O, Hastey C, Brookman R, Lockett Z, Chau J. 673. Updated CLSI Ciprofloxacin Breakpoints from a Multicenter Assessment for Enterobacterales, Salmonella spp. and Pseudomonas aeruginosa Using MicroScan Dried Gram Negative MIC Panels. Open Forum Infect Dis 2020. [PMCID: PMC7776727 DOI: 10.1093/ofid/ofaa439.866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Updated US FDA/CLSI ciprofloxacin breakpoints were evaluated against data from a multicenter clinical study with Enterobacterales, Salmonella spp. and P. aeruginosa on a MicroScan Dried Gram-negative MIC (MSDGN) Panel. MIC results were compared to results obtained with frozen broth microdilution panels prepared according to CLSI methodology.
Methods
MSDGN panels were evaluated at three clinical sites by comparing MIC values obtained using the MSDGN panels to MICs utilizing a CLSI broth microdilution reference panel. Data from the combined phases of efficacy and challenge included 803 Enterobacterales, Salmonella spp. and P. aeruginosa clinical isolates tested using the turbidity and Prompt® methods of inoculation. To demonstrate reproducibility, a subset of 12 organisms were tested on MSDGN panels at each site during reproducibility. MSDGN panels were incubated at 35 ± 1ºC and read on the WalkAway System, the autoSCAN-4 instrument, and visually. Read times for the MSDGN panels were at 16-20 hours. Frozen reference panels were prepared and read according to CLSI methodology. FDA and CLSI breakpoints (µg/mL) used for interpretation of MIC results were: Enterobacterales ≤ 0.25 S, 0.5 I, ≥ 1 R; Salmonella spp. ≤ 0.06 S, 0.12-0.5 I, ≥ 1 R; P. aeruginosa ≤ 0.5 S, 1 I, ≥ 2 R.
Results
Essential and categorical agreement was calculated compared to frozen reference panel results. Results for isolates tested during efficacy and challenge with Prompt inoculation and manual read are as follows:
Conclusion
Ciprofloxacin MIC results for Enterobacterales, Salmonella spp., and P. aeruginosa obtained with the MSDGN panel correlate well with MICs obtained using frozen reference panels using updated FDA/CLSI interpretive criteria in this multicenter study.
* PROMPT® is a registered trademark of 3M Company, St. Paul, MN USA.
BEC, the stylized logo and the BEC product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the US and other countries.
Disclosures
Maria M. Traczewski, BS MT (ASCP), Beckman Coulter (Scientific Research Study Investigator) Denise Beasley, BS, Beckman Coulter (Other Financial or Material Support, Research personnel) Amanda Harrington, PhD, Beckman Coulter (Scientific Research Study Investigator) Sharon DesJarlais, BS, Beckman Coulter (Other Financial or Material Support, Research personnel) Omai Garner, PhD, D(ABMM), Beckman Coulter (Scientific Research Study Investigator) Christine Hastey, PhD, Beckman Coulter (Employee) Regina Brookman, BS, Beckman Coulter (Employee) Zabrina Lockett, MS, Beckman Coulter (Employee) Jennifer Chau, PhD, Beckman Coulter (Employee)
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Affiliation(s)
| | | | | | | | - Omai Garner
- University of California, Los Angeles, Los Angeles, CA
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Gordon L, Adam K, Kelly K, Amin S, Harrington A. 1141. Composition of Placental Cultures and Correlation with Maternal and Infant Blood Cultures in Mothers with Suspected Chorioamnionitis. Open Forum Infect Dis 2020. [PMCID: PMC7776655 DOI: 10.1093/ofid/ofaa439.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Placental culture is often used in combination with placental pathology in pregnant women with suspected chorioamnionitis. While multiple studies have looked at the correlation of placental cultures with neonatal outcomes, few have looked at the composition of placental cultures in terms of the number of organisms and their identification. Our study aims to describe such characteristics of placental cultures and to compare organisms found in placental cultures with those in maternal and infant blood cultures. Methods We performed retrospective chart reviews on mothers and infants for whom a placental pathology and culture was sent at Loyola University Medical Center between January 2017 and December 2019. We separated the mothers based the results of their placental cultures and pathologies and on the number of organisms found in each culture. We then analyzed the identification of organisms of the positive cultures and compared these organisms with positive infant and maternal blood cultures. Results A total of 208 placental cultures out of 279 sent (73.84%) were positive. 63 (30.29%) positive cultures were monomicrobial, while 145 (69.71%) cultures were polymicrobial. The most prevalent organisms found in all placental cultures were coagulase negative staphylococcus (26.44%), Streptococcus anginosus (16.83%), Corynebacterium species (14.90%), Lactobacillus species (14.90%), and Gardnerella vaginalis (13.94%). A small fraction of positive placental cultures was associated with positive infant and maternal blood cultures (4.33% and 3.85%, respectively). When comparing the organisms in placental cultures with those in maternal and infant blood cultures, 100% and 71% (respectively) of cases with both positive blood and placental cultures had shared organisms. Distribution of most common organisms found in monomicrobial and polymicrobial placental cultures. ![]()
Distribution of placental cultures based on number of organisms. ![]()
Correlation of placental cultures with infant and maternal blood cultures. ![]()
Conclusion The data collected from this study helps provide a biological profile of organisms found in placental culture for patients with suspected chorioamnionitis. Additionally, the data suggests that the organisms found in these cultures are often consistent with those found in maternal and infant blood cultures. The overall incidence of positive infant and maternal blood cultures is low as compared to positive placental cultures. Disclosures Amanda Harrington, PhD, Beckman Coulter (Scientific Research Study Investigator)
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Affiliation(s)
- Laurel Gordon
- Loyola University Chicago Stritch School of Medicine, Forest Park, Illinois
| | - Kaavya Adam
- Loyola University Chicago Stritch School of Medicine, Forest Park, Illinois
| | - Kristen Kelly
- Loyola University Chicago Stritch School of Medicine, Forest Park, Illinois
| | - Sachin Amin
- Loyola University Medical Center, Maywood, Illinois
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Betstadt S, Williams D, Whaley N, Flink-Bochacki R, Harrington A. P31 A randomized placebo-controlled trial of ondansetron to reduce emesis associated with oral doxycycline. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Boulet F, Harrington A, Jopling C, Moore-Morris T. The role of NIPBL during cardiac progenitor specification. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bonine NG, Banks E, Harrington A, Vlahiotis A, Moore-Schiltz L, Gillard P. Contemporary treatment utilization among women diagnosed with symptomatic uterine fibroids in the United States. BMC Womens Health 2020; 20:174. [PMID: 32791970 PMCID: PMC7427077 DOI: 10.1186/s12905-020-01005-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 06/28/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study evaluated treatment patterns among women diagnosed with symptomatic uterine fibroids (UF) in the United States. Data were retrospectively extracted from the IBM Watson Health MarketScan® Commercial Claims and Encounters and Medicaid Multi-State databases. METHODS Women aged 18-64 years with ≥1 medical claim with a UF diagnosis (primary position, or secondary position plus ≥1 associated symptom) from January 2010 to June 2015 (Commercial) and January 2009 to December 2014 (Medicaid) were eligible; the first UF claim during these time periods was designated the index date. Data collected 12 months pre- and 12 and 60 months post-diagnosis included clinical/demographic characteristics, pharmacologic/surgical treatments, and surgical complications. Prevalence (2015) and cumulative incidence (Commercial, 2010-2015; Medicaid, 2009-2015) of symptomatic UF were estimated. RESULTS 225,737 (Commercial) and 19,062 (Medicaid) women had a minimum of 12 months post-index continuous enrollment and were eligible for study. Symptomatic UF prevalence and cumulative incidence were: 0.57, 1.23% (Commercial) and 0.46, 0.64% (Medicaid). Initial treatments within 12 months post-diagnosis were surgical (Commercial, 36.7%; Medicaid, 28.7%), pharmacologic (31.7%; 53.0%), or none (31.6%; 18.3%). Pharmacologic treatments were most commonly non-steroidal anti-inflammatory drugs and oral contraceptives; hysterectomy was the most common surgical treatment. Of procedures of abdominal hysterectomy, abdominal myomectomy, uterine artery embolization, and ablation in the first 12 months post-index, 14.9% (Commercial) and 24.9% (Medicaid) resulted in a treatment-associated complication. Abdominal hysterectomy had the highest complication rates (Commercial, 18.5%; Medicaid, 31.0%). CONCLUSIONS Off-label use of pharmacologic therapies and hysterectomy for treatment of symptomatic UF suggests a need for indicated non-invasive treatments for symptomatic UF.
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Affiliation(s)
- Nicole Gidaya Bonine
- Health Economics & Outcomes Research - Canada, Allergan plc, 500 - 85 Enterprise Blvd, Markham, ON, L6G 0B5, Canada.
| | - Erika Banks
- Montefiore Medical Center, Bronx, New York, USA
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Harrington A, Cox B, Snowdon J, Bakst J, Ley E, Grajales P, Maggiore J, Kahn S. Comparison of Abbott ID Now and Abbott m2000 Methods for the Detection of SARS-CoV-2 from Nasopharyngeal and Nasal Swabs from Symptomatic Patients. J Clin Microbiol 2020. [PMID: 32327448 DOI: 10.1128/jcm.00798-20/asset/0c32ffc9-d766-41fc-92cb-33ce62d01246/assets/graphic/jcm.00798-20-f0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- Amanda Harrington
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Brian Cox
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jennifer Snowdon
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jonathan Bakst
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Erin Ley
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Patricia Grajales
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jack Maggiore
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Stephen Kahn
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois, USA
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Lukes AS, Soper D, Harrington A, Sniukiene V, Mo Y, Gillard P, Shulman L. Health-Related Quality of Life With Ulipristal Acetate for Treatment of Uterine Leiomyomas: A Randomized Controlled Trial. Obstet Gynecol 2020; 133:869-878. [PMID: 30969201 PMCID: PMC6485305 DOI: 10.1097/aog.0000000000003211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ulipristal acetate is associated with significant improvements in health-related quality of life and symptom severity compared with placebo in women with symptomatic uterine leiomyomas. OBJECTIVE: To investigate effects of ulipristal acetate on health-related quality of life (QOL) and symptom severity in women with symptomatic uterine leiomyomas and abnormal uterine bleeding. METHODS: Women were randomized to ulipristal (5 mg, 10 mg) or placebo in two phase 3, multicenter, double-blind, placebo-controlled trials (VENUS I and II). Health-related QOL and symptom severity were assessed at baseline, and over one (VENUS I and II) and two (VENUS II) 12-week treatment courses using the Uterine Fibroid Symptom Health-Related Quality of Life questionnaire. In pooled VENUS I and II data, change from baseline to the end of the first course for each Uterine Fibroid Symptom Health-Related Quality of Life scale was analyzed, including a Revised Activities subscale that measured physical and social activities. The proportion of women achieving meaningful change in the Symptom Severity (20 or more points), Health-Related QOL Total (20 or more points), and Revised Activities (30 or more points) scales was calculated. In VENUS II data, change from baseline to the end of each course in each scale was analyzed for each treatment arm. RESULTS: In pooled analyses, the intent-to-treat population included 589 patients (placebo, n=169; ulipristal 5 mg, n=215; ulipristal 10 mg, n=205). Significantly greater improvements from baseline in all Uterine Fibroid Symptom Health-Related Quality of Life scales were observed with both ulipristal doses compared with placebo (P<.001). A meaningful change in Revised Activities was achieved by 51 patients receiving placebo (34.9%), compared with 144 (73.5%; OR 5.0 [97.5% CI 2.9–8.6]) and 141 (80.6%; OR 7.9 [97.5% CI 4.3–14.6]) patients receiving ulipristal 5 mg, and 10 mg, respectively. In VENUS II, at end of courses 1 and 2, both ulipristal doses demonstrated significant improvements from baseline compared with placebo for all Uterine Fibroid Symptom Health-Related Quality of Life scales (P<.01). Mean Revised Activities scores showed that beneficial ulipristal effects were maintained in course 2, and improvements occurred on switching to ulipristal; results for other scales were similar. CONCLUSION: Ulipristal was associated with significant improvements in health-related QOL and symptom severity compared with placebo for women with symptomatic uterine leiomyomas. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02147197 and NCT02147158. FUNDING SOURCE: Allergan plc, Dublin, Ireland.
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Affiliation(s)
- Andrea S Lukes
- Carolina Women's Research and Wellness Center, Durham, North Carolina; Medical University of South Carolina, Charleston, South Carolina; Allergan plc, Irvine, California; Allergan plc, Madison, New Jersey; and the Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Harrington A, Bonine NG, Banks E, Shih V, Stafkey-Mailey D, Fuldeore RM, Yue B, Ye JM, Ta JT, Gillard P. Direct Costs Incurred Among Women Undergoing Surgical Procedures to Treat Uterine Fibroids. J Manag Care Spec Pharm 2020; 26:S2-S10. [PMID: 31958025 PMCID: PMC10408391 DOI: 10.18553/jmcp.2020.26.1-a.s2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Uterine fibroids (UF) affect up to 70%-80% of women by 50 years of age and represent a substantial economic burden on patients and society. Despite the high costs associated with UF, recent studies on the costs of UF-related surgical treatments remain limited. OBJECTIVE To describe the health care resource utilization (HCRU) and all-cause costs among women diagnosed with UF who underwent UF-related surgery. METHODS Data from the IBM MarketScan Commercial Claims and Encounters database and Medicaid Multi-State database were independently, retrospectively analyzed from January 1, 2009, to December 31, 2015. Women aged 18-64 years with ≥ 1 UF claim from January 1, 2010, to December 31, 2014, a claim for a UF-related surgery (hysterectomy, myomectomy, uterine artery embolization [UAE], or ablation) from January 1, 2010, to November 30, 2015, and continuous enrollment for ≥ 1 year presurgery and ≥ 30 days postsurgery qualified for study inclusion. A 1-year period before the date of the first UF-related surgical claim after the first UF diagnosis was used to report baseline demographic and clinical characteristics. Surgery characteristics were reported. All-cause HCRU and costs (adjusted to 2017 U.S. dollars) were described by the 14 days pre-, peri-, and 30 days postoperative periods, and independently by the inpatient or outpatient setting. RESULTS Overall, 113,091 patients were included in this study: commercial database, n = 103,814; Medicaid database, n = 9,277. Median time from the initial UF diagnosis to first UF-related surgical procedure was 33 days for the commercial population and 47 days for the Medicaid population. Hysterectomy was the most common UF-related surgery received after UF diagnosis (commercial, 68% [n = 70,235]; Medicaid, 75% [n = 6,928]). In both populations, 97% of patients had ≥ 1 outpatient visit from 14 days presurgery to 30 days postsurgery (commercial, n = 100,402; Medicaid, n = 9,023), and the majority of all UF-related surgeries occurred in the outpatient setting (commercial, 64% [n = 66,228]; Medicaid, 66% [n = 6,090]). Mean total all-cause costs for patients with UF who underwent any UF-related surgery were $15,813 (SD $13,804) in the commercial population (n = 95,433) and $11,493 (SD $26,724) in the Medicaid population (n = 4,785). Mean total all-cause costs for UF-related surgeries for the commercial/Medicaid populations were $17,450 (SD $13,483)/$12,273 (SD $19,637) for hysterectomy, $14,216 (SD $16,382)/$11,764 (SD $15,478) for myomectomy, $17,163 (SD $13,527)/$12,543 (SD $23,777) for UAE, $8,757 (SD $9,369)/$7,622 (SD $50,750) for ablation, and $12,281 (SD $10,080)/$5,989 (SD $5,617) for myomectomy and ablation. Mean total all-cause costs for any UF-related surgery performed in the outpatient setting in the commercial and Medicaid populations were $14,396 (SD $11,466) and $6,720 (SD $10,374), respectively, whereas costs in the inpatient setting were $18,345 (SD $16,910) and $21,805 (SD $43,244), respectively. CONCLUSIONS This retrospective analysis indicated that surgical treatment options for UF continue to represent a substantial financial burden. This underscores the need for alternative, cost-effective treatments for the management of UF. DISCLOSURES This study was sponsored by Allergan, Dublin, Ireland. Allergan played a role in the conduct, analysis, interpretation, writing of the report, and decision to publish this study. Harrington and Ye are employees of Allergan. Stafkey-Mailey, Fuldeore, and Yue are employees of Xcenda. Ta was a contractor at Allergan at the time the study was conducted and is currently supported by a training grant from Allergan. Bonine, Shih, and Gillard are employees of Allergan and have stock, stock options, and/or restricted stock units as employees of Allergan. Banks has no disclosures to report. This study was presented as a poster at Academy of Managed Care Pharmacy Nexus 2017; October 16-19, 2017; Dallas, TX.
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Affiliation(s)
| | | | - Erika Banks
- Montefiore Medical Center, New York, New York
| | | | | | | | | | | | - Jamie T. Ta
- University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla
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Ying LD, Harrington A, Assi R, Thiessen C, Contessa J, Hubbard M, Yoo P, Nadzam G. Measuring Uncertainty Intolerance in Surgical Residents Using Standardized Assessments. J Surg Res 2020; 245:145-152. [DOI: 10.1016/j.jss.2019.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 02/08/2023]
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35
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Shih V, Banks E, Bonine NG, Harrington A, Stafkey-Mailey D, Yue B, Ye JM, Fuldeore RM, Gillard P. Healthcare resource utilization and costs among women diagnosed with uterine fibroids compared to women without uterine fibroids. Curr Med Res Opin 2019; 35:1925-1935. [PMID: 31290716 DOI: 10.1080/03007995.2019.1642186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To perform a retrospective, matched-cohort, longitudinal evaluation of annual pre- and post-diagnosis costs incurred among women with uterine fibroids (UF) (cases) compared to controls without UF. Methods: Data were derived from the IBM Watson Health MarketScan Commercial Claims and Encounters and Medicaid Multi-State databases. Women aged 18-64 years with ≥1 inpatient or outpatient medical claim with an initial UF diagnosis (index date) from 1 January 2010 to 31 December 2014 were included. Healthcare resource utilization (HCRU) data including pharmacy, outpatient and inpatient hospital claims were collected for 1 year pre-index and ≤5 years post-index. All-cause costs (adjusted to 2017 $US) were compared between cases and controls using multivariable regression models. Results: Analysis included 205,098 (Commercial) and 24,755 (Medicaid) case-control pairs. HCRU and total all-cause healthcare costs were higher for cases versus controls during the pre-index year and all years post-index. Total unadjusted mean all-cause costs were $1197 higher (p < .0001; Commercial) and $2813 higher (standardized difference 0.08; Medicaid) for cases during the pre-index year. Total adjusted mean all-cause costs in the first year post-index were $14,917 for cases versus $5717 for controls in the Commercial population, and $20,244 versus $10,544, respectively, in the Medicaid population. In Years 2-5 post-index, incremental mean adjusted total costs decreased, but remained significantly higher for cases versus controls at all time points in both populations (all p < .05). Conclusions: Costs were higher for women with UF compared to women without UF during the pre-index year and over 5 years post-index; differences were greatest in the first year post-index.
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Affiliation(s)
| | - Erika Banks
- Albert Einstein College of Medicine , Bronx , NY , USA
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Santibañez M, Bunnell K, Harrington A, Bleasdale S, Wenzler E. Association Between Estimated Pharmacokinetic/Pharmacodynamic Predictions of Efficacy and Observed Clinical Outcomes in Obese and Nonobese Patients With Enterobacteriaceae Bloodstream Infections. Open Forum Infect Dis 2019; 6:ofz400. [PMID: 31660362 PMCID: PMC6790397 DOI: 10.1093/ofid/ofz400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/09/2019] [Indexed: 11/12/2022] Open
Abstract
Background Evidence on pharmacokinetic/pharmacodynamic (PK/PD) alterations and clinical outcomes in obese patients with serious infections remains limited. This study aimed to evaluate predicted PK/PD indices of efficacy and observed clinical outcomes between obese and nonobese patients receiving cefepime or piperacillin-tazobactam for Enterobacteriaceae bacteremia. Methods This was a retrospective study of adult inpatients from 1/2012 to 9/2015 with Enterobacteriaceae bacteremia who received empiric cefepime or piperacillin-tazobactam. The primary outcome was clinical cure. First-dose free-drug exposure was estimated via predicted concentrations generated from population PK analyses and used to assess PD target attainment (>50% fT > minimum inhibitory concentration [MIC]) for the specific Enterobacteriaceae isolate. Multivariable logistic regression was utilized to identify independent predictors of clinical cure. Results One hundred forty-two patients were included, 57 obese and 85 nonobese. Clinical cure was achieved in 68.4% of obese and 62.4% of nonobese patients (P = .458). No significant difference in outcomes was observed when evaluated by World Health Organization (WHO) obesity classes. The PK/PD target was achieved in 98.2% of obese and 91.8% of nonobese patients (P = .144). Independent predictors of clinical cure were immunosuppression and a shorter duration of bacteremia. Obesity was not identified as a significant predictor of clinical outcomes. Conclusions Neither predicted PK/PD parameters nor clinical outcomes differed significantly between obese and nonobese patients treated with piperacillin-tazobactam or cefepime. As the majority of patients received extended-infusion piperacillin-tazobactam for bacteremia due to pathogens with low MICs, the potentially detrimental pathophysiologic derangements caused by obesity may not have been realized. Further studies are warranted to establish the optimal treatment of serious infections in obese patients.
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Affiliation(s)
- Melissa Santibañez
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.,College of Pharmacy, Larkin University, Miami, Florida, USA
| | - Kristen Bunnell
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.,Medical College of Wisconsin School of Pharmacy, Milwaukee, WI, USA
| | - Amanda Harrington
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA.,Loyola University Medical Center, Maywood, Illinois, USA
| | - Susan Bleasdale
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Eric Wenzler
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
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Garner O, Traczewski MM, Beasley D, Harrington A, DesJarlais S, Hastey C, Brookman R, Lockett Z, Chau J, Zimmer B. 2131. Multicenter Evaluation of Meropenem/Vaborbactam MIC Results for Enterobacteriaceae Using MicroScan Dried Gram-Negative MIC Panels. Open Forum Infect Dis 2019. [PMCID: PMC6809513 DOI: 10.1093/ofid/ofz360.1811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background A multicenter study was performed to evaluate the accuracy of meropenem/vaborbactam on a MicroScan Dried Gram-negative MIC (MSDGN) Panel when compared with a frozen CLSI broth microdilution reference panel. Methods For efficacy, an evaluation was conducted at three US sites by comparing MIC values obtained using the MSDGN to MICs using a CLSI broth microdilution reference panel. A total of 560 Enterobacteriaceae clinical isolates were tested using the turbidity and Prompt®* methods of inoculation. For challenge, 95 Enterobacteriaceae isolates were tested on MSDGN panels at one site. For reproducibility, a subset of 14 organisms was tested on MSDGN panels at each site. MSDGN panels were incubated at 35 ± 2°C and read on the WalkAway System, the autoSCAN-4 instrument, and read visually. Read times for the MSDGN panels were at 16–20 hours. Frozen reference panels, prepared according to CLSI/ISO methodology, were inoculated using the turbidity inoculation method. All frozen reference panels were incubated at 35 ± 2°C and read visually. Frozen reference panels were read at 16–20 hours. FDA/CLSI breakpoints (µg/ml) used for interpretation of MIC results were: Enterobacteriaceae ≤ 4/8 S, 8/8 I, and ≥ 16/8 R. Results When compared with frozen reference panel results, essential and categorical agreements for isolates tested in the Efficacy and Challenge are as follows (see table). Reproducibility among the three sites were greater than 95% for all read methods for both the turbidity and Prompt* inoculation methods. Conclusion This multicenter study showed that meropenem/vaborbactam MIC results for Enterobacteriaceae obtained with the MSDGN panel correlate well with MICs obtained using frozen reference panels using FDA/CLSI interpretive criteria. * PROMPT® is a registered trademark of 3M Company, St. Paul, MN, USA. Beckman Coulter, the stylized logo and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries. Vabomere® (Meropenem/Vaborbactam) is a registered trademark of Melinta Therapeutics, Inc. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Omai Garner
- UCLA Medical Center, Los Angeles, California
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Yeturu P, Harrington A, Reid G. 1712. Candida auris: A Case Series at a Large Tertiary Care Medical System. Open Forum Infect Dis 2019. [PMCID: PMC6809181 DOI: 10.1093/ofid/ofz360.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Candida Auris has become one of the most feared pathogens globally in a relatively short period of time and, despite increased awareness, its incidence continues to rise. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication.
Methods
Loyola Medicine includes Loyola University Medical Center, a large tertiary care transplant center, and Gottlieb Memorial Hospital, a community-based medical center. Both hospitals have reported cases of Candida auris infection. We reviewed the microbiology laboratory data and clinical information of all positively identified cases over a 17-month period.
Results
Candida auris was isolated from 14 patients in cultures from blood, urine, wounds, and respiratory secretions. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS; Burker, Biotyper RUO) was used for identification in all of the cases and susceptibility testing was performed using microbroth dilution (Sensititre, YeastOne) for all isolates. 7/14 isolates (50%) were considered resistant to fluconazole; however, none were multi-drug resistant. All 14 isolates (100%) were considered susceptible to echinocandins. In addition, all patients were critically ill and had multiple comorbidities.
Conclusion
Candida auris is an emerging global health threat with increasing incidence of infection. Awareness of the pathogen, appropriate contact precautions, and laboratory methods of identification are necessary. Given increasing drug resistance, we recommend susceptibility testing on all isolates.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | | | - Gail Reid
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
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Gavaghan VM, Lee M, Butler D, Biagi M, Santarossa M, Harrington A, Albarillo FS, Wenzler E. 2269. Clinical Outcomes in Patients with Carbapenem-Non-Susceptible, β-Lactam-Susceptible Pseudomonas aeruginosa Infections. Open Forum Infect Dis 2019. [PMCID: PMC6810814 DOI: 10.1093/ofid/ofz360.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Pseudomonas aeruginosa (PsAr) isolates harboring OprD mutations often present phenotypically as carbapenem nonsusceptible but susceptible to antipseudomonal β-lactams (APBLs). It is unknown whether this unique genotype–phenotype combination affects the clinical outcomes of patients infected with these pathogens. The objective of this study was to compare clinical outcomes of patients treated with APBLs for pneumonia and/or bacteremia caused by PsAr bearing this unique carbapenem nonsusceptible, β-lactam susceptible phenotype (Carba-NS) to those retaining susceptibility to both carbapenems and APBLs (Carba-S). Methods Retrospective multicenter cohort of adult in-patients who received effective APBL for PsAr pneumonia and/or bacteremia from January 2012 to November 2018. Baseline characteristics, treatment information, and clinical outcomes were obtained from the electronic medical record. The primary outcome was 14-day mortality. Secondary outcomes included 30-day mortality, 30-day infection recurrence, and infection-related length of stay (IR-LOS). IR-LOS was defined as the time from index culture to antibiotic discontinuation or hospital discharge, whichever was sooner. Descriptive statistics were analyzed using SPSS. Results 387 patients were evaluated; 60 Carba-S and 21 Carba-NS were included. The primary reason for exclusion was ineffective empiric therapy. Select demographics and clinical outcomes are displayed in Table 1. Compared with the Carba-S group, Carba-NS patients were younger, had better renal function, increased incidence of pneumonia, more severely ill, and higher rate of empiric ceftazidime use. Despite these differences at baseline there were no significant differences in empiric APBL treatment patterns, 14- or 30-day mortality, or recurrence at 30 days between the groups. Carba-NS patients had lower rate of oral step down therapy and a significantly longer LOS and IR-LOS. Conclusion In this cohort of patients who received appropriate and timely APBL therapy, the Carba-NS phenotype was not associated with increased rates of 14-day mortality, 30-day mortality, or 30-day infection recurrence. These data suggest that APBLs may be effective therapeutic options against this phenotype. Further research is warranted to confirm these findings. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Michelle Lee
- University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - David Butler
- University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Mark Biagi
- University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | | | | | | | - Eric Wenzler
- University of Illinois at Chicago, Chicago, Illinois
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Traczewski MM, Beasley D, Harrington A, DesJarlais S, Garner O, Hastey C, Brookman R, Lockett Z, Chau J, Zimmer B. 2132. Multicenter Evaluation of Eravacycline MIC Results for Enterobacteriaceae Using MicroScan Dried Gram-Negative MIC Panels. Open Forum Infect Dis 2019. [PMCID: PMC6810403 DOI: 10.1093/ofid/ofz360.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background A multicenter study was performed to evaluate the accuracy of eravacycline on a MicroScan Dried Gram-negative MIC (MSDGN) Panel when compared with a frozen CLSI broth microdilution reference panel. Methods For efficacy, an evaluation was conducted at three sites by comparing MIC values obtained using the MSDGN to MICs using a CLSI broth microdilution reference panel. A total of 414 Enterobacteriaceae clinical isolates were tested using the turbidity and Prompt®* methods of inoculation. For challenge, 79 Enterobacteriaceae isolates were tested on MSDGN panels at one site. For reproducibility, a subset of 11 organisms was tested on MSDGN panels at each site. MSDGN panels were incubated at 35 ± 2°C and read on the WalkAway System, the autoSCAN-4 instrument, and read visually. Read times for the MSDGN panels were at 16–20 hours. Frozen reference panels, prepared according to CLSI/ISO methodology, were inoculated using the turbidity inoculation method. All frozen reference panels were incubated at 35 ± 2°C and read visually. Frozen reference panels were read at 16–20 hours. FDA breakpoints (µg/mL) used for interpretation of MIC results were: Enterobacteriaceae ≤ 0.5 S. Potential major and very major errors were calculated using the NS result in place of resistant (R). Results When compared with frozen reference panel results, essential and categorical agreements for isolates tested in the Efficacy and Challenge are as follows (see table). Reproducibility among the three sites were greater than 95% for all read methods for both the turbidity and Prompt inoculation methods. Conclusion This multicenter study showed that eravacycline MIC results for Enterobacteriaceae obtained with the MSDGN panel correlate well with MICs obtained using frozen reference panels using FDA interpretive criteria. * PROMPT® is a registered trademark of 3M Company, St. Paul, MN USA. Beckman Coulter, the stylized logo and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries. Xerava™ (Eravacycline) is a registered trademark of Tetraphase Pharmaceuticals, Inc. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Omai Garner
- UCLA Medical Center, Los Angeles, California
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Lu Y, Hatch J, Holmberg K, Hurlock A, Drobysheva D, Spaulding U, Vourli S, Pournaras S, Everhart K, Leber A, Barr B, Daly J, Henry T, Johnson A, Balada-Llasat JM, Rhoads DD, Jacobs M, Mc Kinley K, Harrington A, Zhang F, Berry GJ, Hyung Jeong M, She R, Sambri V, Fantini M, Dirani G, Zannoli S, Bourzac K. 651. Multi-Center Evaluation of the BioFire® FilmArray® Blood Culture Identification 2 Panel for the Detection of Microorganisms and Resistance Markers in Positive Blood Cultures. Open Forum Infect Dis 2019. [PMCID: PMC6811262 DOI: 10.1093/ofid/ofz360.719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The BioFire® FilmArray® Blood Culture Identification 2 (BCID2) Panel is a diagnostic test that provides results for 26 bacterial, 7 fungal pathogens and 10 antimicrobial resistance (AMR) genes from positive blood culture (PBC) specimens in about an hour. The BCID2 Panel builds upon the existing BCID Panel with several additional assays that include Candida auris and an expanded AMR gene menu that provides methicillin-resistant Staphylococcus aureus (MRSA) results plus detection for mcr-1, carbapenem resistance, and ESBL. Here, we summarize studies conducted to establish clinical performance using an Investigational Use Only version of the BCID2 Panel. Methods Three studies were performed. The first involves prospective collection and testing of an expected ~1,000 residual PBCs at 7 US and 2 EU sites, which began in October 2018 and will conclude in June 2019. BCID2 Panel performance is compared with reference methods of microbial culture as well as PCR/sequencing for AMR genes. In addition, BCID2 Panel MRSA results are compared with the FDA-cleared Xpert MRSA/SA BC system (Cepheid, Inc). Relevant bacterial isolates recovered from PBCs are also evaluated by various phenotypic antimicrobial susceptibility testing (AST) methods. The prospective evaluation is supplemented with a second study that involves testing of ~300 pre-selected, archived PBCs containing rare organisms. The third study includes over 500 seeded blood cultures containing very rare organisms with an evaluation of co-spiked samples. Results With over 1,200 samples tested to date (out of an anticipated 1,800 total), the BCID2 Panel has demonstrated an overall sensitivity of >98% and specificity of >99% for identification of microorganisms compared with culture. Concordance between the BCID2 Panel and the Xpert MRSA/SA BC test is >99% for identification of MRSA. Evaluation of BCID2 Panel AMR gene detection relative to AST and PCR is ongoing. Conclusion The FilmArray® BCID2 Panel appears to be a sensitive, specific, and robust test for rapid detection of microorganisms and MRSA in PBCs. With the use of this comprehensive test, improved antimicrobial stewardship is anticipated. Disclosures All authors: No reported disclosures
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Affiliation(s)
- Yang Lu
- BioFire Diagnostics, LLC, Sandy, Utah
| | | | | | | | | | | | - Sophia Vourli
- National and Kapodistrian University of Athens, Athens, Zakinthos, Greece
| | - Spyridon Pournaras
- National and Kapodistrian University of Athens, Athens, Zakinthos, Greece
| | | | - Amy Leber
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Becki Barr
- Primary Children’s Hospital, Salt Lake City, Utah
| | - Judy Daly
- Primary Children’s Hospital, Salt Lake City, Utah
| | - Tai Henry
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amy Johnson
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Daniel D Rhoads
- University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Michael Jacobs
- University Hospital Cleveland Medical Center, Cleveland, Ohio
| | | | | | - Frank Zhang
- Northwell Health Labs, Little Neck, New York
| | | | | | - Rosemary She
- University of Southern California, Los Angeles, California
| | - Vittorio Sambri
- The Greater Romagna Area Hub Laboratory, Bologna, Piemonte, Italy
| | - Michela Fantini
- The Greater Romagna Area Hub Laboratory, Bologna, Piemonte, Italy
| | - Giorgio Dirani
- The Greater Romagna Area Hub Laboratory, Bologna, Piemonte, Italy
| | - Silvia Zannoli
- The Greater Romagna Area Hub Laboratory, Bologna, Piemonte, Italy
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Parada JP, Green M, Wright D, Parilla D, Hedlund H, Harrington A, Smith KR. 2431. When More is Less – Recognizing More Community-onset Clostridium difficile Infections Helps to Dramatically Lower C diff Standardized Infection Ratio (SIR). Open Forum Infect Dis 2019. [PMCID: PMC6809553 DOI: 10.1093/ofid/ofz360.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background It is essential to recognize the true burden of community-onset (CO) Clostridium difficile infection (CDI) in hospital, not only because it prevents late recognition of CO CDI as being classified as a hospital-onset (HO) event, but also to assure appropriate contact precautions and therapeutic measures are deployed in a timely fashion. We recognized that our timely diagnosis of CO-CDI was suboptimal and sought to improve early recognition of CO-CDI. Methods We developed an automated daily report for all patients during their first 3 days of hospitalization who had loose stools documented in the nursing flow sheets and no stool sample sent to the lab. This report was automatically pushed out to the unit nurse managers, as well as reviewed by the infection preventionists (IP). Nurse managers alerted staff to acquire a stool sample to send to the lab. If stool testing still was not sent at the time of IP review of these symptomatic cases, then the IP called the nurse caring for the patient to encourage that a stool sample be sent ASAP and before the third hospital day was completed. Results We increased early appropriate stool testing for patients with documented loose stools during the first 3 days of hospitalization. Improved early diagnosis and better lab stewardship was associated with a marked increase in CO-CDI (15.6/month in 2015 vs 58.7/month in the last year), as well as a decrease in HO-CDI (22.8/month in 2015 vs 7.4/month last year) (Figure 1). In turn, we saw a remarkable drop in our CDI SIR (2 year pre-intervention SIR = 1.49 vs post-intervention SIR for the last 1.5 years = 0.41) (Figure 2). Conclusion After several years of our CDI SIR remaining stubbornly around 1.5, we developed a system of enhanced recognition of patients who had loose stools early in their hospitalization. This aided in better recognition of CDI present on admission, substantially increasing our detection of CO-CDI. We also noted decreases in HO-CDI, presumably secondary to no longer diagnosing patients later in their hospitalization as HO-CDI cases who actually had been admitted with CO-CDI. Better early recognition and isolation of patients with CDI also helped to decrease inadvertent C. difficile transmission in hospital, contributing to decreases in HO-CDI. In turn, we noted a remarkable decrease in our CDI SIR. ![]()
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Disclosures All authors: No reported disclosures.
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Coyne KS, Harrington A, Currie BM, Chen J, Gillard P, Spies JB. Psychometric validation of the 1-month recall Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire (UFS-QOL). J Patient Rep Outcomes 2019; 3:57. [PMID: 31444600 PMCID: PMC6708009 DOI: 10.1186/s41687-019-0146-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/06/2019] [Indexed: 01/15/2023] Open
Abstract
Background To evaluate the psychometric characteristics of the 1-month recall Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire (UFS-QOL), including the Revised Activities subscale. Methods VENUS I and II were phase III, randomized, double-blind, placebo-controlled trials of ulipristal acetate in women with uterine fibroids (UF) and abnormal uterine bleeding. Women completed the 1-month recall UFS-QOL at baseline and after 12 weeks’ treatment. Uterine bleeding was assessed via a daily diary (both studies); the Patient Global Impression of Improvement scale (PGI-I) was completed in VENUS II. Psychometric analyses examined internal consistency reliability and construct validity of the UFS-QOL; confirmatory factor analysis (CFA) compared model fit of the original and Revised Activities subscales. Analyses were conducted separately for VENUS I and II. Results One hundred and fifty-seven patients in VENUS I and 429 in VENUS II were included. Changes in mean Symptom Severity and health-related quality of life (HRQoL) scale scores indicated symptom burden reductions and HRQoL improvements. Cronbach’s alpha coefficients were high at baseline and after 12 weeks’ treatment (all ≥0.76, meeting the >0.70 threshold), demonstrating strong internal consistency reliability. Correlations between UFS-QOL scores and bleeding diary responses (range: −0.35 to −0.63), and UFS-QOL scores and PGI-I responses (range: −0.48 to −0.70), ranged from moderate to strong after 12 weeks’ treatment (all p < 0.0001). Patients with absence of bleeding or controlled bleeding after 12 weeks’ treatment scored significantly better (p < 0.001) on each UFS-QOL scale than patients not achieving those end points, supporting construct validity. CFA confirmed model fit for the Revised Activities subscale. Conclusions The 1-month recall UFS-QOL, including the Revised Activities subscale, is a valid, reliable measure to assess UF symptoms and their impact on HRQoL. Trial registration ClinicalTrials.gov, NCT02147197. Registered May 26, 2014; retrospectively registered. ClinicalTrials.gov, NCT02147158. Registered May 26, 2014; retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s41687-019-0146-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin S Coyne
- , Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | | | - Brooke M Currie
- , Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Jun Chen
- , Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | | | - James B Spies
- MedStar Georgetown University Hospital, Washington, DC, USA
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Lukes AS, Soper D, Harrington A, Sniukiene V, Mo Y, Gillard P, Shulman L. Health-related Quality of Life With Ulipristal Acetate for Treatment of Uterine Leiomyomas: A Randomized Controlled Trial. Obstet Gynecol Surv 2019. [DOI: 10.1097/01.ogx.0000576968.19384.3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chinthammit C, Harrington A, Wild A, Werner S, Boesen K, Taylor AM, Warholak TL. Retrospective Review of Exceptions for Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Recommendations for a Diabetic Medicare Population. J Manag Care Spec Pharm 2019; 25:358-365. [PMID: 30816812 PMCID: PMC10398062 DOI: 10.18553/jmcp.2019.25.3.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Renin-angiotensin system (RAS) antagonists are recommended for people with diabetes and hypertension or with elevated urinary albumin excretion. RAS antagonists are beneficial for some, yet clinically inappropriate for others. The percentage of patients for whom RASs are clinically inappropriate has not been compared across health plans. OBJECTIVES To (a) identify reasons why RAS therapy was not recommended and (b) compare exception percentages between health plans. METHODS This retrospective, cross-sectional analysis included Medicare Part D beneficiaries with diabetes, enrolled in health plans (n = 96) participating in a university-based medication therapy management (MTM) program between January 1 and December 31, 2013. The MTM program evaluated patient eligibility for RAS therapy via (1) a clinically derived software system assessing demographics and medication history, and (2) telepharmacist-delivered medication reviews. The MTM program database calculated the number of patients with diabetes and percentage of RAS therapy exceptions. RESULTS An average of 55% of patients with diabetes qualified for MTM (range: 19%-88%). Of the 218,589 eligible, 94,359 had 1 or more reasons contraindicating RAS therapy (exception). For an average of 29% of patients, it was inappropriate to recommend the addition of an RAS antagonist; the overall exception rate ranged from 3% to 83%, suggesting a wide variation of exception rates for all health plans. CONCLUSIONS A substantial difference existed across health plans where RAS therapy was considered clinically inappropriate to recommend for patients with diabetes. Future research must examine variations in therapy exceptions to understand the effect of encouraging broad-population RAS antagonist use. DISCLOSURES SinfoníaRx provided funding for this project. Wild, Boesen, and Werner are employed by SinfoniaRx, which provided grant funding to the University of Arizona College of Pharmacy for the conduct of this study. This project was presented at the AMCP 27th Annual Meeting and Expo; April 8-10, 2015; San Diego, CA.
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Affiliation(s)
- Chanadda Chinthammit
- 1 Department of Pharmaceutical Sciences, University of Arizona College of Pharmacy, Tucson
| | - Amanda Harrington
- 1 Department of Pharmaceutical Sciences, University of Arizona College of Pharmacy, Tucson
| | | | | | | | - Ann M Taylor
- 1 Department of Pharmaceutical Sciences, University of Arizona College of Pharmacy, Tucson
| | - Terri L Warholak
- 1 Department of Pharmaceutical Sciences, University of Arizona College of Pharmacy, Tucson
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Dobiesz V, Yost G, Robinson N, Kutz-McClain P, Esmailbeigi H, Collofello B, Harrington A, Koch A, Geller S. Correction to: In Pursuit of Solving a Global Health Problem: Prototype Medical Device for Autotransfusing Life-Threatening Postpartum Hemorrhage in Resource-Limited Settings. Curr Obstet Gynecol Rep 2018. [DOI: 10.1007/s13669-018-0249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Parada JP, Wright D, Boldyga A, Abuihmoud A, Green M, Hedlund H, Harrington A, Smith KR. 530. The Perfect Storm for Improved Standardized Infection Ratio (SIR)—Recognizing More Community-onset Clostridium difficile Infections Increases the Expected Number of C. difficile Cases While also Helping to Decrease the Actual Observed Number of Hospital Onset C. difficile Cases. Open Forum Infect Dis 2018. [PMCID: PMC6255664 DOI: 10.1093/ofid/ofy210.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background It is essential to recognize the true burden of community-onset (CO) Clostridium difficile infection (CDI) in hospital, not only because it prevents late recognition of CO CDI as being classified as a hospital-onset (HO) event, but also to assure appropriate contact precautions and therapeutic measures are deployed in a timely fashion. We recognized that our timely diagnosis of CO-CDI was suboptimal and sought to improve early recognition of CO-CDI. Methods We developed an automated daily report of all patients noted to have loose stools documented in the nursing flow sheets during the first 3 days of hospitalization. This report was automatically forwarded to the nurse manager of the unit, as well as was reviewed daily, Monday–Friday, by the infection preventionists (IP) to determine whether stool testing had been sent on these symptomatic patients. If not, then the IP would call the nurse caring for the patient and encourage that a stool sample be sent ASAP and before the third hospital day was completed. Results With this intervention, we increased early appropriate stool testing for patients with documented loose stools during the first 3 days of hospitalization leading to a marked increase in CO-CDI, as well as a notable decrease in HO-CDI lab ID events (Figure 1). Together, the increased recognition of CO-CDI increased our expected cases/SIR denominator and decreased observed cases/SIR numerator and substantially dropped our CDI SIR from a 2 years preintervention median SIR of 1.47 to 0.95 during the five quarters since the intervention has been in effect. Conclusion After several years of our CDI SIR remaining stubbornly around 1.5, we developed a system of enhanced recognition of patients who had loose stools early in their admission. This practice aided better recognition of CDI present on admission, substantially increasing our detection of CO-CDI. We also noted decreases in HO-CDI, in part secondary to no longer diagnosing patients who actually had CO-CDI later in their hospitalization and classifying CO-CDI as HO-CDI cases. In turn, we noted a remarkable decrease in our CDI SIR. ![]()
Disclosures J. P. Parada, Merck: Speaker’s Bureau, Speaker honorarium. A. Harrington, Biofire: Grant Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium. Cepheid: Grant Investigator and Speaker’s Bureau, Research grant.
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Pons B, Jay C, Martin T, Sothier I, Savelli H, Kensinger B, Laurent F, Abad L, Murphy C, Craney A, Schmitt B, Waggoner A, Butler-Wu S, Costales C, Bien-Bard J, Mestas J, Esteban J, Salar-Vidal L, Harrington A, Collier S, Leber A, Everhart K, Balada-Llasat JM, D P, Horn J, Magro S, Bourzac K. 2290. Identification of Pathogens in Synovial Fluid Samples With an Automated Multiplexed Molecular Detection System. Open Forum Infect Dis 2018. [PMCID: PMC6253585 DOI: 10.1093/ofid/ofy210.1943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Bone and Joint Infections (BJI) have high morbidity and are difficult to treat infections. Culture-based diagnosis is limited in its ability to recover fastidious bacteria and because several organisms can be involved; culture times of up to two weeks may be necessary for certain bacteria. The sensitivity of culture is also negatively impacted by antibiotics received before surgery. Alternatively, molecular methods offer a promising improvement for the diagnosis of BJI. The goal of this study was to evaluate a development version of Biofire® Bone and Joint Infection (BJI) Panel (bioMerieux SA, BioFire Diagnostics, LLC) using synovial fluid samples. Methods 121 synovial fluid specimens were collected from patients with suspected bone and joint infection in a pilot evaluation. All specimens were collected and tested in culture by the sites using their standard of care practices; in parallel, a leftover volume of 200 µL was tested on the BJI panel. BJI panel results were then compared with culture and discordant results were investigated using a comparator assay (PCR/sequencing). Results 49 synovial fluid specimens (40%) were positive by culture vs. 72 with the BJI panel (59%). Of the 97 positive detections by the BJI panel, 58 were concordant with culture; the 39 additional organism detections were in majority confirmed by PCR/sequencing. Lastly, two false negative results corresponding to the same sample are under investigation. Conclusion The BJI Panel was able to identify most of the pathogens detected by culture. The majority of additional detections observed were confirmed by PCR/sequencing. While sites are currently enrolling more synovial fluids samples, these preliminary data suggest that a multiplexed molecular test may be more sensitive than culture to detect pathogens in synovial fluid specimens. The data presented in this abstract have not been reviewed by FDA or other regulatory agencies for In Vitro Diagnostic use. Disclosures B. Pons, bioMerieux: Employee, Salary. C. Jay, bioMerieux: Employee, Salary. T. Martin, bioMerieux: Employee, Salary. I. Sothier, bioMerieux: Employee, Salary. H. Savelli, bioMerieux: Employee, Salary. B. Kensinger, bioFire a bioMerieux company: Employee, Salary. F. Laurent, BioFire (bioMerieux company): Investigator, Research support. L. Abad, BioFire (bioMerieux company): Investigator, Research support. C. Murphy, BioFire (bioMerieux company): Investigator, Research support. A. Craney, BioFire (bioMerieux company): Investigator, Research support. B. Schmitt, BioFire (bioMerieux company): Investigator, Research support. A. Waggoner, BioFire (bioMerieux company): Investigator, Research support. S. Butler-Wu, BioFire (bioMerieux): Investigator, Research support. C. Costales, BioFire (bioMerieux company): Investigator, Research support. J. Bien-Bard, BioFire (bioMerieux): Investigator, Research support. J. Mestas, BioFire (bioMerieux): Investigator, Research support. J. Esteban, BioFire (bioMerieux): Investigator, Research support. L. Salar-Vidal, BioFire (BioMerieux company)): Investigator, Research support. A. Harrington, BioFire (bioMerieux company): Investigator, Research support. S. Collier, BioFire (BioMerieux Company): Investigator, Research support. A. Leber, BioFire (bioMerieux company): Investigator, Research support. K. Everhart, BioFire (bioMerieux company): Investigator, Research support. J. M. Balada-Llasat, BioFire (bioMerieux company): Investigator, Research support. J. Horn, BioFire (bioMerieux company): Investigator, Research support. S. Magro, bioMerieux: Employee, Salary. K. Bourzac, BioFire a bioMerieux company: Employee, Salary.
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Affiliation(s)
| | - Corinne Jay
- Molecular Biology R&D, Biomerieux, Grenoble, France
| | | | | | | | | | - Frédéric Laurent
- Hospices Civils De Lyon, French National Reference Center for Staphylococci, Lyon, France
| | - Lelia Abad
- Hospices Civils De Lyon, French National Reference Center for Staphylococci, Lyon, France
| | | | - Arryn Craney
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryan Schmitt
- Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | - Amy Waggoner
- Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | | | | | | | - Javier Mestas
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Jaime Esteban
- Department of Clinical Microbiology, Foundation Jimenez Diaz, Madrid, Spain
| | - Llanos Salar-Vidal
- Department of Clinical Microbiology, Foundation Jimenez Diaz, Madrid, Spain
| | | | | | - Amy Leber
- Department of Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Kathy Everhart
- Department of Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Pharm D
- Clinical Microbiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jarid Horn
- Clinical Microbiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Parada JP, Wright D, Suarez-Ponce S, Trulis E, Linchangco P, Abuihmoud A, Pua H, Green M, Hedlund H, Smith KR, Harrington A. 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR). Open Forum Infect Dis 2018. [PMCID: PMC6255454 DOI: 10.1093/ofid/ofy210.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | | | | | | | | | | | - Herminia Pua
- Loyola University Medical Center, Maywood, Illinois
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Harrington A, Straker J. Long Term Services and Supports: Nursing Homes and Other Institutions. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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