Background. Anticoagulation therapy with warfarin is common before heart transplantation and complicates perioperative management.Methods. This single-center, noninterventional, retrospective cohort study evaluated heart transplant patients before and after institution of a prothrombin complex concentrates-based preoperative warfarin reversal protocol for heart transplantation. Patients with international normalized ratio (INR) greater than 1.5 who received prothrombin complex concentrate (PCC) before heart transplant surgery were compared with a control group before implementation of a PCC protocol. Coprimary endpoints were utilization of individual blood products. Secondary endpoints included in-hospital mortality, reoperation for bleeding, delayed sternal closure, thromboembolic events, duration of chest tube use, time to extubation, intensive care unit length of stay, and hospital length of stay.Results. The study included 106 consecutive heart transplant patients (PCC cohort [ 57, historical control cohort [ 49). There was a significant reduction in fresh
BackgroundEvidence available to guide perioperative antibiotic prophylaxis for endoscopic endonasal (EEN) procedures remains limited. The primary objective of this study was to characterize the impact of antibiotic prophylaxis on the incidence of post-operative central nervous system (CNS) or sinonasal infections in patients undergoing EEN procedures.MethodsThis was an IRB-approved descriptive analysis including patients >18 years of age who underwent EEN surgery at AdventHealth Orlando over a 3-year period. Patients were excluded if they had an infection present prior to surgery, ongoing antibiotic treatment (other than surgical prophylaxis) at the time of surgery, or a basic sinonasal surgery which lacked CNS penetration. The primary endpoint assessed was the rate of CNS or sinonasal infection within 30 days of EEN procedure.ResultsAfter screening 160 patient encounters, a total of 118 patients were included. The most common antibiotic prophylaxis utilized was ceftriaxone, followed by cefazolin, or alternative/combination therapy (72.8% vs. 13.6% vs. 13.6% of cases, respectively). There were 4 total patients who met the primary endpoint, and all 4 cases were due to a diagnosis of meningitis (overall rate 3.4%). Infection rate by antibiotic prophylaxis was 2.4% for ceftriaxone, 0% for cefazolin, and 14.3% for alternative/combination therapy. Based upon the retrospective nature of this study, we were unable to account for provider preference in selection of surgical prophylaxis or other surgeon-specific factors.ConclusionIn this retrospective descriptive analysis, rates of CNS or sinonasal infections occurred at a rate similar to previously published literature. Larger, prospective studies are warranted to evaluate the impact of antibiotic selection on the rate of CNS or sinonasal infections post-EEN procedures. Disclosures All authors: No reported disclosures.
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Introduction: Here, we aimed to evaluate primary prescription nonadherence post-discharge from an acute inpatient psychiatric unit. Prescription nonadherence is a concern across all patient care settings, with primary nonadherence defined as not picking up prescribed medication from the pharmacy or not delivering prescriptions to the pharmacy. Secondary nonadherence, defined as filling a prescription but not taking the medication as prescribed, was not tracked in this study. The incidence of nonadherence can vary widely across settings and has been reported to range from 3 to 86%. This is a particular concern in patients with a primary psychiatric diagnosis both in an outpatient and inpatient setting. Design: The prescription fill rate of eligible patients was tracked on days 7 and 21 post-discharge from acute inpatient psychiatric units of an acute care multispecialty urban community teaching hospital. Results: In total, 72 patients aged 18 and above (44%, women) were analyzed. A primary nonadherence incidence of 43% was found, which did not vary significantly across the analyzed variables of age, sex, or primary diagnosis. Conclusion: Primary nonadherence is a significant issue in this population. Strategies, such as the implementation of med-to-bed programs and use of longer acting injectables when appropriate, would help in increasing adherence. Further research, including the evaluation of other variables that affect nonadherence, is needed in order to identify and develop steps to overcome the obstacles to adherence.
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