Objective Outside pregnancy, nitrofurantoin, ciprofloxacin and sulfamethoxazole-trimethoprim (SMZ-TMP) are first-line therapy (FLT) for lower urinary tract infections (LUTIs). Optimal antibiotics for LUTI have been extrapolated based on expert opinion. Progression to pyelonephritis and adverse obstetric outcomes were compared between women who received FLT and those given alternative antibiotics.
Methods This study includes a retrospective cohort of women with LUTI, including asymptomatic bacteriuria and acute cystitis at single health care system from July 2013 to May 2019. Women receiving FLT, defined as nitrofurantoin or SMZ-TMP, were compared with those receiving nonfirst-line therapy (nFLT). Primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis-related anemia, sepsis, length of stay, preterm birth (PTB), and low birth weight (LBW). Logistic regression was used to calculate odds of outcomes.
Results Of 476 women, 336 (70.6%) received FLT and 140 (29.4%) received nFLT. Women receiving FLT were more likely having BMI ≥ 40 (p = 0.04). Progression to pyelonephritis did not differ (5.8 vs. 8.2%; p = 0.44), nor did other pyelonephritis-related outcomes. After controlling for confounders, no difference in odds of progression to pyelonephritis was seen (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 0.42, 2.49). FLT was not associated with PTB or LBW (aOR 0.60, 95% CI 0.29, 1.26) after controlling for confounders.
Conclusion Receipt of antibiotics other than nitrofurantoin or SMZ-TMP for LUTI in pregnancy was not associated with increased risk of progression to pyelonephritis, PTB, or LBW.
102 Background: Electronic patient-reported outcome measures (ePROs) offer a new strategy for symptom assessment that can improve quality of life and prolong survival in routine cancer care. However, ePRO systems are often separate from existing electronic medical records (EMRs) and not well integrated into oncology clinics. In this pilot project, we assessed the feasibility and utility of integrating ePROs into our existing EMR and clinical workflows. Methods: The 10-question Edmonton Symptom Assessment Scale (ESAS) was integrated into the Epic EMR at three outpatient clinics in the Duke Cancer Institute. Patients with active MyChart accounts were offered the ESAS survey prior to their visit, via the patient portal. ePRO data were routed to clinicians in tabular and graphical formats. A “SmartPhrase” facilitated easy data integration into clinical notes. We subsequently interviewed clinicians and optimized workflows. Several patient engagement strategies were used, including automated messages, phone call reminders, and electronic tablets, to increase response rate. Results: It was feasible to quickly customize and activate an ePRO in Epic. Over 10 months, 161 patients completed 208 ePRO surveys. Initially, 10-20% of eligible patients completed the MyChart questionnaire. Patient engagement strategies, including phone calls and personalized MyChart messages, had little effect. Ultimately, tablets were introduced in the clinic check-in process, increasing response rates to >90%. Clinicians reported positive regard for the system, and an impact on patient symptom management. Clinician workflow optimization resulted in minimal “clicks” in the EMR, and the SmartPhrase was used in 128 clinical notes. Conclusions: Integration of ePROs into the clinical setting poses three challenges: technical implementation, workflow optimization, and patient engagement. While technical implementation is important, it was the easiest to solve, with patient engagement as the greatest barrier. Clinicians value an integrated ePRO system that automatically routes data to the clinical note. The key to successful ePRO integration is in ease of use for both patients and clinicians.
Upon neuropathological assessment ACS exposure resulted in a persistent lower neuron density and less Ki67+ cells in particularly the hippocampus (Figure 2). CONCLUSION: Clinical equivalent ACS exposure in this late preterm rabbit model resulted in a persistent growth restriction, worse neurobehavior performance and lasting altered neuronal milieu.
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