Introduction Quality of life (QoL) deficits have been noted among patients with venous thromboembolism (VTE) but understanding of the drivers of that poorer QoL is limited. The objective of this study was to examine associations between a variety of factors and QoL in patients with VTE. Methods Adult patients who had experienced at least one VTE episode within the past 2 years completed an online survey between May and July 2016 with responses to a variety of questions designed to ascertain QoL scores, Optum Short Form-12, and potential factors associated with these scores. Results Most of the 907 patients were female (56.7%) and Caucasian (88.6%). Physical and mental QoL scores below the general population average were present in 76.0 and 56.7% of patients, respectively. Multiple regression modeling revealed several factors associated with below average physical QoL scores including unemployment (odds ratio [OR] 3.77, 95% confidence interval [CI] 1.76–8.05), gastrointestinal bleeding (OR 2.54, 95% CI 1.28–5.01), high depression scores (OR 4.02, 95% CI 1.88–8.58), or difficulty accessing VTE care (OR 4.24, 95% CI 1.77–10.17). Factors associated with below average mental QoL scores included experiencing VTE within the last month (OR 3.85, 95% CI 1.58–9.41), unemployment (OR 2.83, 95% CI 1.30–6.16), or high depression (OR 3.85, 95% CI 1.60–9.28) and/or anxiety (OR 9.17, 95% CI 4.81–17.47) scores. Conclusion Most patients with recently diagnosed VTE reported below average QoL. Many of the factors associated with below average QoL are modifiable, indicating that patients with VTE could potentially benefit from interventions aimed at improving QoL.
Background Recent studies in gram-negative bacteremia (GNB) suggest intravenous (IV) to oral (PO) switch and short treatment durations yield similar clinical outcomes and fewer adverse events. Antimicrobial stewardship program (ASP) bundled initiatives have been associated with improved clinical outcomes for blood stream infections. Methods This single-center retrospective cohort evaluation included inpatient adults from 11/2014-10/2015 and 10/2017-9/2018 with GNB. The pre-ASP period was prior to the establishment of an ASP program. In the post-period, the ASP promoted IV to PO switches, avoidance of repeat blood cultures, and short treatment durations for patients with uncomplicated GNB. The primary outcome was duration of antibiotic therapy. Secondary outcomes included associated process measures with the bundle and clinical outcomes. Results 137 patients met criteria for inclusion, with 51 patients in the pre- group, and 86 patients in the post- group. Background characteristics were similar between groups. The median duration of therapy was 14 days (IQR = 10-16) in the pre- group and 10 days (7-14) in the post- group (p<0.001). The median day of IV to PO switch was on day 5 (4-6) in the pre- group versus day 4 (3-5) in the post- group (p=0.046). Average total hospital cost per case decreased by 27% in the post- group (p=0.19). Mortality rates and bacteremia recurrence were not significantly different between groups. Conclusions An ASP bundle for uncomplicated GNB was associated with reduced durations of therapy and earlier PO switch. These findings highlight the synergistic role of ASPs in optimizing antibiotic use and promoting patient safety.
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