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Hospital discharge documentation and risk of rehospitalisation

Hansen, Luke O; Strater, Amy; Smith, Lisa; Lee, Jungwha; Press, Robert; Ward, Norman; Weigelt, John A; Boling, Peter; Williams, Mark V
BACKGROUND Avoidable hospital readmission is a focus of quality improvement efforts. The effectiveness of individual elements of the standard discharge process in reducing rehospitalisation is unknown. METHODS The authors conducted a case-control study of 1039 patients experiencing rehospitalisation within 30 days of discharge and 981 non-rehospitalised patients matched on admission diagnosis, discharge disposition, and severity of illness. In separate models for each discharge process component, the authors measured the relationship between readmission and discharge summary completion, contents of discharge summary, completion of discharge instructions, contents of discharge instructions, presence of caregiver for discharge instruction, completion of medication reconciliation, and arrangement of ambulatory follow-up prior to discharge. RESULTS Adjusting for patient and hospital characteristics, including severity of illness and discharge disposition, the study failed to find an association between readmission and most components of the discharge process. There was no association between readmission and medication reconciliation, transmission of discharge summary to an outpatient physician, or documentation of any specific aspect of discharge instruction. Associations were found between readmission and discharge with followup arranged (adjusted odds ratio (OR) 1.21; 95% CI 1.05 to 1.37) and increasing number of medicines (adjusted OR 1.02; 95% CI 1.01 to 1.04). CONCLUSIONS Documentation of discharge process components in the medical record may not reflect actual discharge process activities. Alternatively, mandated discharge processes are ineffective in preventing readmission. The observed absence of an association between discharge documentation and readmission indicates that discharge quality improvement initiatives should target metrics of discharge process quality beyond improving rates of documentation
PMID: 21515695
ISSN: 2044-5423
CID: 138014

Successful management of orbital cellulitis and temporary visual loss after blepharoplasty [Case Report]

Chiu, Ernest S; Capell, Brian C; Press, Robert; Aston, Sherell J; Jelks, Elizabeth B; Jelks, Glenn W
PMID: 16932160
ISSN: 1529-4242
CID: 159222

Rational antibiotic treatment of outpatient genitourinary infections in a changing environment

David, RD; DeBlieux, PMC; Press, R
In the outpatient setting, genitourinary infections (GUIs) remain costly to treat and are a significant cause of morbidity. Recent evidence supports more substantial roles for pathogens other than Escherichia coli, particularly gram-positive pathogens, in the pathogenesis of GUIs. Broad-spectrum agents should be considered in order to address this etiologic change appropriately. Criteria for antimicrobial selection set forth by the Council for Appropriate and Rational Antibiotic Therapy (CARAT) recommend using antibiotics that are supported by strong clinical evidence, have good susceptibility profiles, are safe, are cost-effective, and are used for the optimal duration. Evidence-based guidelines recommend considering local E coli resistance rates to trimethoprim-sulfamethoxazole and using fluoroquinolones as second-line therapy when resistance is high. Fluoroquinolones are recommended for the treatment of pyclonephritis and prostatitis. Among the fluoroquinolones, levofloxacin and gatifloxacin offer coverage for the gram-negative and gram-positive pathogens, which may make them preferable in treating urinary tract infections empirically in such patient groups. For the treatment of bacterial prositatitis, only trimethoprim and the fluoroquinolones possess both the appropriate bactericidal activity and the ability to diffuse into the prostate. Levofloxacin shows particularly good penetration into prostatic tissue. Safety issues to consider include imbalances in intestinal microflora caused by antimicrobial. agents that may lead to overgrowth of vancomycin-resistant enterococci and Clostridium difficile-associated diarrhea. Once the optimal agent is identified, the optimal duration of,treatment should be determined to maximize treatment success while minimizing the potential for resistance. Finally, cost considerations include the costs of treatment failure due to inappropriate therapy or nonadherence to the therapeutic regimen. (C) 2005 Elsevier Inc. All rights reserved
ISI:000230567600002
ISSN: 0002-9343
CID: 56314

Linezolid-associated toxic optic neuropathy: a report of 2 cases [Case Report]

Lee, Elsie; Burger, Susanne; Shah, Jilan; Melton, Christine; Mullen, Michael; Warren, Floyd; Press, Robert
We describe 2 cases in which the prolonged use of linezolid to treat complicated methicillin-resistant Staphylococcus aureus infections was followed by acutely developed blurred vision and progressive loss of vision and color perception during the ensuing few weeks. Both patients received a diagnosis of toxic optic neuropathy, and linezolid therapy was stopped. The patients experienced an initial rapid partial improvement and a subsequent gradual, almost complete, recovery over many months
PMID: 14583875
ISSN: 1537-6591
CID: 39015

Linezolid-resistant, vancomycin-resistant Enterococcus faecium infection in patients without prior exposure to linezolid [Case Report]

Rahim, Sibtain; Pillai, Satish K; Gold, Howard S; Venkataraman, Lata; Inglima, Kenneth; Press, Robert A
We describe 2 patients without prior exposure to linezolid who were infected with closely related strains of linezolid- and vancomycin-resistant Enterococcus faecium (LRVREF) that may have been hospital acquired. Polymerase chain reaction amplification of the domain V region of the 23S ribosomal RNA gene demonstrated the presence of the G2576U mutation previously reported to be associated with linezolid resistance. Nosocomial transmission of LRVREF is an ominous sign and underscores the importance of meticulous infection-control measures
PMID: 12766857
ISSN: 1537-6591
CID: 97050

The use of fluoroquinolones as antiinfective transition-therapy agents in community-acquired pneumonia

Press RA
The newer quinolone antibiotics, including levofloxacin, moxifloxacin, and gatifloxacin, offer coverage of the likely pathogens in community-acquired pneumonia (CAP) and have been shown to be safe and effective treatments for CAP. Two of these agents, levofloxacin and gatifloxacin, have pharmacokinetic and antibacterial properties that are similar in both oral and intravenous formulations. As such, they may be excellent candidates for transition therapy involving early switch from intravenous to oral therapy followed by early hospital discharge for patients with CAP
PMID: 11446520
ISSN: 0277-0008
CID: 21135

Recurrent mucormycosis of the paranasal sinuses in an immunologically competent host [Case Report]

Tyson JC; Gittelman PD; Jacobs JB; Holliday R; Press R
PMID: 1528591
ISSN: 0194-5998
CID: 13536

Neutropenic typhlitis simulating carcinoma of the cecum [Case Report]

Musher DR; Amorosi EL; Gouge T; Megibow AJ; Press RA
PMID: 2792682
ISSN: 0016-5107
CID: 10496

CEPHALOSPORIN THERAPY IN INTRAABDOMINAL INFECTIONS - A MULTICENTER RANDOMIZED, COMPARATIVE-STUDY OF CEFOTETAN, MOXALACTAM, AND CEFOXITIN

Wilson, SE; Boswick, JA; Duma, RJ; Echols, RM; Jemsek, JG; Lerner, R; Lewis, RT; Najem, AZ; Press, RA; Rittenbury, MS; Stone, HH; Ton, GT
ISI:A1988N718300012
ISSN: 0002-9610
CID: 31601

Comparative study of cefotetan and cefoxitin in the treatment of intra-abdominal infections

Lewis, R T; Duma, R J; Echols, R M; Jemsek, J G; Najem, A Z; Press, R A; Stone, H H; Ton, G T; Wilson, S E
One hundred eighty-eight patients were enrolled in a multicenter, randomized clinical trial to compare the safety and effectiveness of 1 to 2 gm cefotetan every 12 hours with those of 1 to 2 gm cefoxitin every 6 hours in patients with intra-abdominal infections. Most of the infections were community acquired, were associated with gastrointestinal tract perforation, and were caused by both anaerobic and aerobic bacteria. The median duration of therapy was 6 days for each group. The clinical response rate for the 95 evaluable patients in the cefotetan group was 98%, and that for the 43 evaluable patients in the cefoxitin group was 95%. Bacteriologically, 97% of the 58 evaluable patients in the cefotetan group and 89% of the 27 evaluable patients in the cefoxitin group had a satisfactory or presumed satisfactory response; two patients in the cefotetan group and three in the cefoxitin group were considered bacteriologic failures. Cefotetan was as effective as cefoxitin in eradicating Bacteroides fragilis and other species of Bacteroides, Clostridium sp., and gram-negative bacilli. The incidence of treatment-related adverse reactions for cefotetan (27%) was not statistically different from that for cefoxitin (17%). No clinically significant differences were detected between the treatment groups in changes in the results of clinical laboratory tests performed before and after treatment; a decrease in hematocrit among the cefotetan group was statistically greater (p = 0.04) than that for the cefoxitin group, and a decrease in serum creatinine level for the cefoxitin group was greater than that for the cefotetan group (p = 0.02). Cefotetan may represent an effective, safe, and cost-saving alternative to cefoxitin for the prompt treatment of community-acquired intra-abdominal infections.
PMID: 3281463
ISSN: 0002-9378
CID: 3891892