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Esteve-Matalí L, Vargas I, Plaja P, Cots F, Mayer EF, Pérez-Castejón JM, Escosa A, Ramon I, Abizanda M, Vázquez ML. Understanding how to improve the use of clinical coordination mechanisms between levels of care. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.359] [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
Background
Clinical coordination mechanisms (CCM) can play an important role in improving clinical coordination between primary (PC) and secondary care (SC) doctors, being necessary to understand the reasons hindering their use. The aim is to analyse the level of use of CCM, and the difficulties and factors associated to it.
Methods
Cross-sectional study based on an online survey using the COORDENA-CAT questionnaire (October-December 2017). Sample: 3308 doctors of the Catalan national health system. Outcome variables: frequent use of six CCM and difficulties in their use. Explanatory variables: sociodemographic, labour characteristics, organizational and interactional factors. Stratification variable: level of care. Analysis: descriptive bivariate and multivariate by logistic regression.
Results
The level of use differed according to the CCM and level of care, being lower for the different cross-level consultations (via electronic medical record -EMR: 52.36%, email: 26.11% and phone: 21.73%). Shared EMR of the organisation (81.27%) and of the region (65.89%), and joint clinical case conferences (63.28%) were the most frequently used, especially by PC doctors, and the ones presenting more difficulties in use. While the difficulties pointed to organizational problems, mostly related to computer and schedule problems, the analysis of factors pointed also to some individual factors. Working in integrated areas or with local hospitals were factors positively associated with the use of CCM. Interactional factors, such as personally knowing the other level doctor, were associated among SC doctors.
Conclusions
The use of CCM differed across mechanisms and level of care, and was clearly improvable. Difficulties and factors affecting their use were mostly organizational, so managerial support is required to create the appropriate conditions for their use. It is also important to strengthen interaction between doctors of different care levels to improve the use of CCM.
Key messages
The level of use of CCM differed according to the mechanism and level of care, and was clearly improvable. This study identifies difficulties and factors affecting their use, mainly organizational. These results are useful for managers promoting strategies to improve clinical coordination by the effective implementation of CCM, which require managerial support and interaction between doctors.
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Affiliation(s)
- L Esteve-Matalí
- Health Policy Research Unit, Consortium for Health care and Social Services of Catalonia, Barcelona, Spain
| | - I Vargas
- Health Policy Research Unit, Consortium for Health care and Social Services of Catalonia, Barcelona, Spain
| | - P Plaja
- Fundació Salut Empordà, Figueres, Spain
| | - F Cots
- Parc de Salut Mar, Barcelona, Spain
| | - EF Mayer
- Serveis de Salut Integrats Baix Empordà, Palamós, Spain
| | | | - A Escosa
- Institut Català de la Salut, Barcelona, Spain
| | - I Ramon
- Consorci Hospitalari de Vic, Vic, Spain
| | - M Abizanda
- Parc Sanitari Pere Virgili, Barcelona, Spain
| | - ML Vázquez
- Health Policy Research Unit, Consortium for Health care and Social Services of Catalonia, Barcelona, Spain
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Abstract
The clinical manifestations of SARS-CoV-2 infection, the causative agent of COVID-19, mainly involve the respiratory system. However, there is increasing evidence that this virus can affect other organs causing a wide arrange of clinical symptoms. In this report, we present the case of 14-year-old boy with acute abdominal pain, with laboratory and radiologic findings consistent with acute pancreatitis, without any risk factors except for a SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | - Erick F Mayer
- Department of Pediatrics
- Department of Research, Serveis Integrats de Salut Baix Empordà, Girona, Spain
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Mayer EF, Maron G, Dallas RH, Ferrolino J, Tang L, Sun Y, Danziger-Isakov L, Paulsen GC, Fisher BT, Vora SB, Englund J, Steinbach WJ, Michaels M, Green M, Yeganeh N, Gibson JE, Dominguez SR, Nicholson MR, Dulek DE, Ardura MI, Rajan S, Gonzalez BE, Beneri C, Herold BC. A multicenter study to define the epidemiology and outcomes of Clostridioides difficile infection in pediatric hematopoietic cell and solid organ transplant recipients. Am J Transplant 2020; 20:2133-2142. [PMID: 32064754 DOI: 10.1111/ajt.15826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/08/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 01/25/2023]
Abstract
Hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients are at increased risk for Clostridioides difficile infection (CDI). We conducted a multicenter retrospective study to describe the incidence of CDI in children transplanted between January 2010 and June 2013. Nested case-control substudies, matched 1:1 by transplant type, institution, patient age, and time of year (quartile) of transplant, identified CDI risk factors. Cohorts included 1496 HCT and 1090 SOT recipients. Among HCT recipients, 355 CDI episodes were diagnosed in 265 recipients (18.2%). Nested case-control study identified prior history of CDI (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.5-4.7), proton pump inhibitors (PPIs; OR 2.1, 95% CI 1.3-3.4), and exposure to third- (OR 2.4, 95% CI 1.4-4.2) or fourth-generation (OR 2.1, 95% CI 1.2-3.7) cephalosporins as risk factors. Notably, fluoroquinolone exposure appeared protective (OR 0.6, 95% CI 0.3-0.9). Ninety-two episodes of CDI were diagnosed among 79 SOT recipients (7.3%), and exposure to PPIs (OR 2.4, 95% CI 1.1-5.4) and third-generation cephalosporin therapy (OR 3.9, 95% CI 1.4-10.5) were identified as risk factors. Strategies to decrease PPI use and changes in the class of prophylactic antibiotics may impact CDI incidence and warrant further study.
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Affiliation(s)
- Erick F Mayer
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York, USA
| | - Gabriela Maron
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ronald H Dallas
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jose Ferrolino
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Li Tang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yilun Sun
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Grant C Paulsen
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brian T Fisher
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Surabhi B Vora
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Janet Englund
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - William J Steinbach
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Marian Michaels
- Department of Pediatrics & Surgery, Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Green
- Department of Pediatrics & Surgery, Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nava Yeganeh
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| | - Joy E Gibson
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Samuel R Dominguez
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Maribeth R Nicholson
- Department of Pediatrics, Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- Department of Pediatrics, Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Monica I Ardura
- Department of Pediatrics & Host Defense Program, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sujatha Rajan
- Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA
| | | | - Christy Beneri
- Department of Pediatric, Stony Brook School of Medicine, Stony Brook, New York, USA
| | - Betsy C Herold
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York, USA.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
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Youssef AS, Fanous M, Siddiqui FJ, Estrada J, Chorny V, Braiman M, Mayer EF. Value of Blood Cultures in the Management of Children Hospitalized with Community-Acquired Pneumonia. Cureus 2020; 12:e8222. [PMID: 32582483 PMCID: PMC7306671 DOI: 10.7759/cureus.8222] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and objectives Current guidelines for the management of community-acquired pneumonia (CAP) in children recommend obtaining a blood culture for children with moderate to severe pneumonia; yet, there is no guidance to assess the severity of the disease. Thus, a blood culture is obtained for the majority of children admitted with CAP, regardless of the severity of their symptoms. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia. Methods We conducted a medical record review of children aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers. We used binary logistic regression analysis and chi-square tests to look at factors associated with blood culture positivity. Results A total of 464 patients were admitted with CAP. Blood cultures were obtained in 357 (76.9%) patients; 23 patients had repeated cultures. Fifteen patients had positive cultures: 5/380 (1.3%) were considered true positive results and 10/380 (2.6%) were considered contaminants. Intensive care unit (ICU) admission (OR 5.6 with 95% CI (1- 31), p<0.03), toxic appearance (OR 12.8 with 95% CI (1.3-125), p<0.01), and significantly elevated C-reactive protein (CRP) (>300 mg/L (p<0.01) were associated with bacteremia. Conclusion The prevalence of bacteremia among children admitted for CAP is low. The use of routine blood cultures should be reserved for children with moderate to severe pneumonia. Further studies are required to better risk-stratify children with CAP.
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Affiliation(s)
- Ahmed S Youssef
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
| | - Mina Fanous
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
| | - Faisal J Siddiqui
- Neonatology, State University of New York Downstate Medical Center, New York, USA
| | | | - Valeriy Chorny
- Pediatrics, New York University School of Medicine, New York, USA
| | - Melvyn Braiman
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
| | - Erick F Mayer
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
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Weiler N, Mayer EF, Kazlouskaya V, Bamgbola OF, Banniettis N, Heilman E, Glick SA. Infective dermatitis associated with HTLV-1 infection in a girl from Trinidad: Case report and review of literature. Pediatr Dermatol 2019; 36:e12-e16. [PMID: 30338553 DOI: 10.1111/pde.13702] [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: 11/28/2022]
Abstract
Infective dermatitis (ID) associated with Human T-cell leukemia virus type-1 (HTLV-1) is a rare form of severe superinfected eczema seen mostly in the Caribbean islands and Latin America. Although rapid response to antibiotic treatment is observed, patients should be monitored for development of complications associated with this retroviral infection, including T-cell leukemia/lymphoma (ATLL) and HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). Infective dermatitis is rarely seen in the United States and therefore may be under-recognized by physicians unfamiliar with this condition. Herein, we present an additional case report of an ID associated with HTLV-1 in an 11-year-old girl from Trinidad.
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Affiliation(s)
- Nicole Weiler
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Erick F Mayer
- Department of Pediatric Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | | | - Oluwatoyin F Bamgbola
- Department of Pediatric Nephrology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Natalie Banniettis
- Department of Pediatric Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Edward Heilman
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sharon A Glick
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
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Ita F, Mayer EF, Verdonck K, Gonzalez E, Clark D, Gotuzzo E. Human T-lymphotropic virus type 1 infection is frequent in rural communities of the southern Andes of Peru. Int J Infect Dis 2013; 19:46-52. [PMID: 24262672 DOI: 10.1016/j.ijid.2013.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 06/06/2013] [Revised: 10/03/2013] [Accepted: 10/05/2013] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate the presence of human T-lymphotropic virus type 1 (HTLV-1) infection in isolated rural communities in the southern Andes of Peru. METHODS We conducted a cross-sectional study in five communities located in three provinces in Ayacucho, Peru. The five communities are located at >3000 meters above sea level and are mainly rural, and more than 85% of the population speaks Quechua. Volunteers aged 12 years and older were included. Clinical and epidemiological data were collected, along with a blood sample for serological testing. RESULTS We included 397 participants; their median age was 41 years (interquartile range 31-57 years) and 69% were women. According to our definitions, 98% were of Quechua origin. HTLV-1 was diagnosed in 11 people: 0/164 in Cangallo, 3/154 (2%) in Vilcashuaman, and 8/79 (10%) in Parinacochas. There were no cases of HTLV-2. All the HTLV-1-positive participants were born in Ayacucho and were of Quechua origin; they ranged in age from 29 to 87 years (median 56 years) and 10/11 were women. Ten were apparently healthy, and one woman was diagnosed with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Three out of 11 had a family member with a lower limb impairment compatible with HAM/TSP. CONCLUSION The fact that HTLV-1 infection was present in two out of three provinces suggests that HTLV-1 could be highly endemic in the southern Andes in the Quechua population.
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Affiliation(s)
- Fanny Ita
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Erick F Mayer
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kristien Verdonck
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru; Institute of Tropical Medicine, Antwerp, Belgium
| | - Elsa Gonzalez
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Clark
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru; Laboratorios de Investigación y Desarrollo (LID), Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduardo Gotuzzo
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Nacional Cayetano Heredia, Lima, Peru
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Mayer EF, Ita F, Gonzalez E, Verdonck K, Bravo F, Clark D, Gotuzzo E. Association between onychodystrophy and human T-lymphotropic virus type 1 infection. Int J Infect Dis 2012; 17:e312-6. [PMID: 23245620 DOI: 10.1016/j.ijid.2012.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To assess the association between human T-lymphotropic virus type 1 (HTLV-1) infection and onychodystrophy. METHODS This was a cross-sectional study. At our institute, we provide HTLV-1 testing to relatives of HTLV-1-infected people and patients with suspected HTLV-1-associated diseases. The diagnosis of onychodystrophy was made clinically before testing for HTLV-1; the number and distribution of affected nails was registered. We assessed the association between onychodystrophy and HTLV-1 through bi- and multivariable analyses. Logistic regression was used to adjust for age, sex, and indication for HTLV-1 testing, using six affected nails (90(th) percentile) as the cut-off point. RESULTS Between April 2006 and March 2008, we included 893 subjects; their mean age was 38 years (standard deviation 19 years), and 527 (59%) were women. Onychodystrophy of one or more nails was observed in 323 participants (36%), and 236 subjects (26%) were HTLV-1-positive. The median number of affected nails was higher in HTLV-1-positive than in HTLV-1-negative subjects (Mann-Whitney test, p < 0.001). Thirty-eight of 97 subjects with six or more affected nails (39%) were HTLV-1-infected, compared to 198 of 796 subjects with fewer than six affected nails (25%) (crude OR 1.9, 95% confidence interval (CI) 1.2-3.1; p = 0.003). This association remained significant in the multiple logistic regression model (adjusted OR 2.0, 95% CI 1.2-3.3; p = 0.005). CONCLUSIONS There is an independent association between HTLV-1 infection and onychodystrophy. Patients with an HTLV-1 infection might have a higher risk for onychomycosis given the abnormal nail plate and a decreased T-cell-mediated immunologic response.
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Affiliation(s)
- Erick F Mayer
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.
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