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Greenville, NC, United States

Weber J.J.,East Carolina University | Mascarenhas D.C.,Vidant Medical Center | Bellin L.S.,East Carolina University | Raab R.E.,East Carolina University | And 2 more authors.
Annals of Surgical Oncology | Year: 2012

Purpose. Patient navigation programs are initiated to help guide patients through barriers in a complex cancer care system. We sought to analyze the impact of our patient navigator program on the adherence to specific Breast Cancer Care Quality Indicators (BCCQI). Methods. A retrospective cohort of patients with stage I-III breast cancer seen the calendar year prior to the initiation of the patient navigation program were compared with patients treated in the ensuing two calendar years. Quality indicators deemed appropriate for analysis were those associated with overcoming barriers to treatment and those associated with providing health education and improving patient decision-making. Results. A total of 134 consecutive patients between January 1, 2006 and December 31, 2006 and 234 consecutive patients between January 1, 2008 and December 31, 2009 were evaluated for compliance with the BCCQI. There was no significant difference in the mean age or race/ethnic distribution of the study population. In all ten BCCQI evaluated, there was improvement in the percentage of patients in compliance from pre and post implementation of a patient navigator program (range 2.5-27.0 %). Overall, compliance with BCCQI improved from 74.1 to 95.5 % (p<0.0001). Indicators associated with informed decision-making and patient preference achieved statistical significance, while only completion axillary node dissection in sentinel nodepositive biopsies in the process of treatment achieved statistical significance. Conclusions. The implementation of a patient navigator program improved breast cancer care as measured by BCCQI. The impact on disease-free and overall survival remains to be determined. © Society of Surgical Oncology 2012. Source

Rimawi R.H.,East Carolina University | Mazer M.A.,East Carolina University | Siraj D.S.,East Carolina University | Gooch M.,Vidant Medical Center | Cook P.P.,East Carolina University
Critical Care Medicine | Year: 2013

Objective:: Antimicrobial stewardship programs have been shown to help reduce the use of unnecessary antimicrobial agents in the hospital setting. To date, there has been very little data focusing on high-use areas, such as the medical ICU. A prospective intervention was done to assess guideline compliance, antimicrobial expenditure, and healthcare cost when an infectious disease fellow interacts regularly with the medical ICU team. Design:: A 3-month retrospective chart review was followed by a 3-month prospective intervention the following year. Two hundred forty-six total charts were reviewed to assess generally accepted guideline compliance, demographics, and microbiologic results. Setting:: Twenty-four-bed medical ICU at an 861-bed tertiary care, university teaching hospital in North Carolina. Subjects:: Patients receiving antibiotics in the medical ICU. Intervention:: During the intervention period, the infectious disease fellow reviewed the charts, including physician notes and microbiology data, and discussed antimicrobial use with the medical ICU team. Measurements and main Results:: Antimicrobial use, treatment duration, Acute Physiology and Chronic Health Evaluation II scores, length of stay, mechanical ventilation days, and mortality rates were compared during the two periods. Results:: No baseline statistically significant differences in the two groups were noted (i.e., age, gender, race, or Acute Physiology and Chronic Healthcare Evaluation II scores). Indications for antibiotics included healthcare- associated (53%) and community-acquired pneumonias (17%). Significant reductions were seen in extended-spectrum penicillins (p = 0.0080), carbapenems (p = 0.0013), vancomycin (p = 0.0040), and metronidazole (p = 0.0004) following the intervention. Antimicrobial modification led to an increase in narrow-spectrum penicillins (p = 0.0322). The intervention group had a significantly lower rate of treatments that did not correspond to guidelines (p < 0.0001). There was a reduction in mechanical ventilation days (p = 0.0053), length of stay (p = 0.0188), and hospital mortality (p = 0.0367). The annual calculated healthcare savings was $89,944 in early antibiotic cessation alone. Conclusion:: Active communication with an infectious disease practitioner can significantly reduce medical ICU antibiotic overuse by earlier modification or cessation of antibiotics without increasing mortality. This in turn can reduce healthcare costs, foster prodigious education, and strengthen relations between the subspecialties. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Source

Cook P.P.,East Carolina University | Gooch M.,Vidant Medical Center
International Journal of Antimicrobial Agents | Year: 2015

Antimicrobial stewardship has been shown to reduce unnecessary antibiotic use, but there are few data on the long-term benefits of such a programme. Antimicrobial use over a 13-year period since implementing an antimicrobial stewardship programme (ASP) at our institution was examined. Nosocomial rates of Clostridium difficile infection (CDI) and antimicrobial susceptibility patterns of common nosocomial micro-organisms over the same period were also reviewed. Total antimicrobial use decreased by 62.8% (P < 0.0001). There were decreases in use of aminoglycosides (-91.3%; P < 0.0001), cephalosporins (-68.3%; P < 0.0001), extended-spectrum penicillins (-77.7%; P < 0.0001), macrolides (-27.2%; P = 0.002), clindamycin (-95.9%; P < 0.0001) and quinolones (-78.7%; P < 0.0001). Antifungal use decreased by 71.0% (P < 0.0001). There were increases in the use of carbapenems (+736%, P < 0.0001) and anti-MRSA drugs (+73.3%; P < 0.0001). There was a 56.7% (P = 0.007) reduction in nosocomial MRSA infections. Nosocomial CDI rates decreased by 42.6% (P = 0.005) between 2003 and 2010 and then increased to near baseline levels following implementation of more sensitive testing for detection of CDI in 2011. There were decreases in the rate (-71.9%; P = 0.001) and percentage (-51.4%; P < 0.0001) of quinolone-resistant Pseudomonas aeruginosa. There were decreases in the rate (P < 0.0001) and percentage (P = 0.02) of carbapenem-resistant P. aeruginosa following implementation of a policy restricting ciprofloxacin use. We have demonstrated sustained reductions in both antimicrobial use and drug-resistant organisms following implementation of an ASP. © 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. Source

Lawler S.,Vidant Medical Center
North Carolina medical journal | Year: 2013

The Centers for Medicare & Medicaid Services (CMS) is seeking to transform Medicare by purchasing "value" from health care providers and physicians. At Vidant Medical Center, we have begun to link the requirements of the CMS Value-Based Purchasing Program to the goals and objectives embedded within our quality improvement initiatives. Source

Quidley A.M.,Vidant Medical Center | Bland C.M.,U.S. Army | Bland C.M.,University of South Carolina
American Journal of Health-System Pharmacy | Year: 2014

Purpose: The perioperative management of bariatric surgery patients is described.Summary: Obesity and anatomical changes create unique challenges for clinicians when caring for bariatric surgery patients. Common bariatric surgery procedures performed include Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric ban.ding. Pain management in the acute postoperative period depends on careful dosing of opioid agents and the use of adjunctive agents. Prevention and management of infectious complications include appropriate surgical prophylaxis, monitoring and rapid treatment of suspected intra-Abdominal infections, and detection and treatment of Helicobacter pylori infection. Venous thromboembolism (VTE) prophylaxis and treatment are complicated by obesity, and the use of pharmacologic agents must be balanced with bleeding risk. Bleeding is a serious complication that should be closely monitored in the immediate postoperative period. Blood products remain first-line therapy for the treatment of bleeding in this population. Acute differences in drug absorption as well as emerging hormonal changes necessitate the immediate postoperative adjustment of chronic medications to ensure both safety and efficacy. Pharmacists are valuable members of interprofessional teams for bariatric surgery patients because they provide expertise on the availability of dosage forms and dosage modification to ensure that patient pharmacotherapy is not interrupted; assist in the management of hypertension, diabetes, and psychotropic medications; and ensure appropriate antimicrobial prophylaxis and VTE prophylaxis and treatment dosages.Conclusion: The management of patients in the perioperative period of bariatric surgery requires appropriate selection and dosing of medications for pain management and treatment of infectious complications, VTE, bleeding, and other chronic diseases. © 2014, American Society of Health-System Pharmacists, Inc. Source

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