Background The frequency and significance of cytomegalovirus (CMV) infection in seropositive (R+) heart transplant recipients (HTR) is unclear, with preventative recommendations mostly extrapolated from other groups. We evaluated the incidence and severity of CMV infection in R+ HTR, to identify risk factors and describe outcomes. Methods R+ HTR from 2010 to 2019 were included. Antiviral prophylaxis was not routinely used, with clinically guided monitoring the local standard of care. The primary outcome was CMV infection within one‐year post‐transplant; secondary outcomes included other herpesvirus infections and mortality. Results CMV infection occurred in 27/155 (17%) R+ HTR. Patients with CMV had a longer hospitalization (27 vs. 20 days, unadjusted HR 1.02, 95% CI 1.00–1.02, p = .01), higher rate of intensive care readmission (26% vs. 9%, unadjusted HR 3.46, 1.46–8.20, p = .005), and increased mortality (33% vs. 8%, unadjusted HR 10.60, 4.52–24.88, p < .001). The association between CMV and death persisted after adjusting for multiple confounders (HR 24.19, 95% CI 7.47–78.30, p < .001). Valganciclovir prophylaxis was used in 35/155 (23%) and was protective against CMV (infection rate 4% vs. 27%, adjusted HR .07, .01–.72, p = .025), even though those receiving it were more likely to have received thymoglobulin (adjusted OR 10.5, 95% CI 2.01–55.0, p = .005). Conclusions CMV infection is common in R+ HTR and is associated with a high burden of disease and increased mortality. Patients who received valganciclovir prophylaxis were less likely to develop CMV infection, despite being at higher risk. These findings support the routine use of antiviral prophylaxis following heart transplantation in all CMV R+ patients.
Purpose This study aims to investigate the factors that influence South African customers to potentially switch from one bank to another. Instead of using established models and survey techniques, the research measured social media sentiment to measure threats to switch. Design/methodology/approach The research involved a 12-month analysis of social media sentiment, specifically customer threats to switch banks (churn). These threats were then analysed for co-occurring themes to provide data on the reasons customers were making these threats. The study used over 1.7 million social media posts and focused on all five major South African retail banks (essentially the entire sector). Findings This study concluded that seven factors are most significant in understanding the underlying causes of churn. These are turnaround time, accusations of unethical behaviour, billing or payments, telephonic interactions, branches or stores, fraud or scams and unresponsiveness. Originality/value This study is unique in its measurement of unsolicited social media sentiment as opposed to most churn-related research that uses survey- or customer-data-based methods. In addition, this study observed the sentiment of customers from all major retail banks across 12 months. To date, no studies on retail bank churn theory have provided such an extensive perspective. The findings contribute to Susan Keaveney’s churn theory and provide a new measurement of switching threat through social media sentiment analysis.
:To describe the use of levosimendan in a quaternary referral center with a dedicated heart failure service and compare its efficacy and safety to continuous outpatient support with inotropes (COSI) among patients with advanced heart failure (AHF) who require bridge-to-decision (BTD) or bridge-to-transplant (BTT) therapy. This study was a retrospective, single-center, descriptive study of patients with AHF who received either a single levosimendan infusion or COSI between 2018 and 2021. A total of 23 patients received a levosimendan infusion, and 14 were started on COSI. Three indications for levosimendan were identified: (1) to facilitate weaning of continuous inotropes, (2) to augment diuresis in cardiorenal syndrome, and (3) as first-line therapy for cardiogenic shock in selected patients. Eighty-three percent (19 of 23) of patients who received levosimendan survived to discharge, and there were few clinically significant adverse events. Overall survival at 12 months among patients who received levosimendan was 74%. No statistically significant difference in survival was observed at 12 months (P = 0.68) or beyond (P = 0.63) between patients who received levosimendan and were discharged with a plan for BTD or BTT and those who received COSI. Levosimendan is a safe and effective short-term therapy in AHF and offers comparable long-term survival to COSI in patients who require BTD or BTT therapy.
There are few studies evaluating the workforce and the time allocated to tasks performed by clinical specialty pharmacists in Australia. The aim of this study was to quantify the time that clinical specialty pharmacists spend on various activities. A Work Observation Method by Activity Timing (WOMBAT) time and motion study was conducted at a tertiary-referral metropolitan health service with comprehensive unit-based clinical pharmacy services. Direct observations of clinical pharmacists were conducted by researchers during weekdays. Tasks and times observed were categorised into domains of 'What, Who, How, and Where', accounting for interruptions and multitasking. Eighteen clinical cardiology, respiratory, and geriatric pharmacists were observed over 171.2 h. The majority of time involved direct patient care activities (76.1% [95% confidence interval 72.6-79.6%]), including admission-related (7.6%), discharge-related (16.2%), and inpatient clinical tasks (52.5%). Activities were undertaken independently (55.9%) with doctors (26.2%), with nurses (10.5%), or with patients (9.6)%; 19.1% of the pharmacist's day involved multitasking. The tasks most frequently performed together were inpatient clinical activities, including rounding and daily medicine review. This study quantified the typical task allocation of clinical pharmacists in cardiology, respiratory, and geriatric units. It demonstrated that in a hospital setting supported by comprehensive operational pharmacy services, clinical pharmacists working in acute and subacute clinical specialities, predominately undertake direct patient care tasks that have been shown to improve patient safety.
Heart failure contributes substantially to morbidity and mortality in older people. It is a chronic and progressive disease, with prevalence set to increase with the ageing population as incidence is strongly associated with age. There are many pharmacotherapies available for the treatment of heart failure which reduce morbidity and mortality. These include angiotensin converting enzyme inhibitors, beta-blockers, mineralocorticoid receptor antagonists and more recently angiotensin receptor-neprilysin inhibitor and sodium glucose co-transporter type 2 inhibitors. Older people are under-represented in large randomised clinical trials and therefore data supporting efficacy and safety of heart failure treatments for older people is not as strong as it is for younger people. Additionally, older people with heart failure have higher rates of polypharmacy, comorbidity, cognitive impairment and frailty. This article summarises the principles of heart failure therapy based on evidence-based guidelines as well as the challenges of appropriate management in older people.
Introduction: Significant evidence-to-practice gaps in osteoporosis management have led to national guidelines, the impact of which is unknown. We evaluated osteoporosis assessment and management after hospital admission to a major metropolitan centre with minimal trauma fracture (MTF) in the context of Australian osteoporosis guidelines. Method: This retrospective analysis included patients over 50 years of age who were admitted to hospital for over 48 h with MTF from 1st January to 31st December 2015. All emergency department (ED) presentations for fracture were identified by diagnosis coding, and 60% were randomly selected for hand-screening to exclude traumatic, pathological, facial and digit fractures. Data were collected from medical records, and inpatient and discharge osteoporosis management was compared to Australian guideline recommendations. Results: Of 1355 patients presenting to the ED with fracture in 2015, 805 were screened, with 272 eligible for inclusion. Median age was 83 years (IQR 73-88); 69% were female, 161 participants (59%) presented with a hip or vertebral fracture and 80 (29%) participants had a documented pre-existing osteoporosis diagnosis. Anti-resorptive medications were indicated for 189 participants according to guidelines, though were only prescribed for one-third of these patients (n = 65/189, 34%). Bone mineral density testing was warranted in a further 83 patients, and undertaken in nine (11%). Only 110 participants (40%) had the words "osteoporosis" or "osteopenia" documented in their discharge summary. Discussion: Health professionals involved in the care of hospitalised patients with MTF are still missing opportunities to prevent future harms by commencing appropriate management to reduce subsequent fracture risk.
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