Activity

Health utilities are commonly used as quality weights to calculate quality-adjusted life years in cost-utility analysis (CUA). However, if published health utilities are not properly used, the credibility of CUA could be affected.

To identify discrepancies in using published health utilities in CUAs for cardiovascular disease (CVD).

CVD CUAs in the Tufts Cost-Effectiveness Analysis Registry that reported health utilities were included in the analysis. References cited for health utilities in these CUAs were reviewed to identify the original health utility studies. The description and value of health utilities used in the CUA were compared with those reported in the original utility studies. Logistic regression was used to identify the factors that can predict the discrepancy.

A total of 585 eligible CUAs published between 1977 and 2016 were identified and reviewed. Of these studies, 74.5% were published between 2007 and 2016. 442 CUAs that used a total of 2235 health utilities published in 203 originaent about how published health utilities are selected and incorporated into CUAs.

Human milk banks play an essential role by providing human milk to infants who would otherwise not be able to receive mother’s milk.

To determine the opinions and attitudes among possible donor mothers regarding human milk banks in one rural region in Bangladesh.

A prospective, cross-sectional study following a probability type of stratified cluster sampling technique was used. Included in the study (

121) were mothers aged 20-49 years, with at least one child, who was currently lactating or had breastfed her child, and who resided in the rural community of Bangladesh where the study was conducted. Data were collected through a 21-item, close-ended questionnaire and a face-to-face interview conducted by the researcher at each participant’s home.

Among the participants, 98.3% (

119) said that they had not heard about human milk banks before speaking with the researchers. Most participants (71.9%,

87) said would obtain human milk from milk banks if necessary, but 28% (

34) of mothers indicated tactices.The purpose of this narrative synthesis of the curriculum-based measure (CBM) instructional utility literature is to deepen insight into the supports required to enrich teachers’ instructional decision-making within curriculum-based measure-data-based individualization (CBM-DBI) in ways that enhance the learning outcomes of students with intensive intervention needs, including students with learning disabilities. We begin by summarizing a recent meta-analysis of CBM-DBI studies focused on academic outcomes. We then reconsider studies from that meta-analysis to further explore the supports required to enrich teachers’ instructional decision-making within CBM-DBI and improve student learning. selleck chemicals We next draw conclusions and propose a renewed program of instructional utility CBM-DBI research for capitalizing on technology’s potential to enhance productive instructional decision-making for students who require intensive intervention, fulfill DBI’s potential, and bring CBM-DBI to scale.

Utilization of rapid diagnostic testing alongside intensive antimicrobial stewardship interventions improves patient outcomes. We sought to determine the clinical impact of a rapid blood culture identification (BCID) panel in an established Antimicrobial Stewardship Program (ASP) with limited personnel resources.

A single center retrospective pre- and post-intervention cohort study was performed following the implementation of a BCID panel on patients admitted with at least 1 positive blood culture during the study period. The primary outcome was time to optimal therapy from blood culture collection. Secondary outcomes included days of therapy (DOT), length of stay, and 30-day mortality and readmission rates.

277 patients were screened with 180 patients included, with 82 patients in the pre-BCID and 98 in the post-BCID arms. Median time to optimal therapy was 73.8 hours (IQR; 1.1-79.6) in the pre-BCID arm and 34.7 hours (IQR; 10.9-71.6) in the post-BCID arm (p ≤ 0.001). Median DOT for vancomycin was 4 and 3 days (p ≤ 0.001), and for piperacillin-tazobactam was 3.5 and 2 days (p ≤ 0.007), for the pre-BCID and post-BCID arms, respectively. Median length of hospitalization was decreased from 11 to 9 days (p = 0.031). No significant change in 30-day readmission rate was noted, with a trend toward lower mortality (12% vs 5%; p = 0.086).

Introduction of BCID into the daily workflow resulted in a significant reduction in time to optimal therapy for bloodstream infections and DOT for select broad-spectrum antibiotics, highlighting the potential benefits of rapid diagnostics even in settings with limited personnel resources.

Introduction of BCID into the daily workflow resulted in a significant reduction in time to optimal therapy for bloodstream infections and DOT for select broad-spectrum antibiotics, highlighting the potential benefits of rapid diagnostics even in settings with limited personnel resources.

Although strategies for optimization of pharmacologic therapy in patients with heart failure with reduced ejection fraction (HFrEF) are scripted by guidelines, data from HF registries suggests that guideline-directed medical therapies (GDMT) are underutilized among eligible patients. Whether this discrepancy reflects medication intolerance, contraindications, or a quality of care issue remains unclear.

The objective of this initiative was to identify reasons for underutilization and under-dosing of HFrEF therapy in patients at a large, academic medical center.

Among 500 patients with HFrEF enrolled in a quality improvement project at a tertiary center, we evaluated usage and dosing of 4 categories of GDMT ACE inhibitors/Angiotensin Receptor Blockers (ACE-i/ARB), Angiotensin Receptor-Neprilysin Inhibitors (ARNi), beta blockers, and Mineralocorticoid Receptor Antagonists (MRA). Reasons for nonprescription and usage of suboptimal doses were abstracted from notes in the chart and from telephone review of prcumented medication intolerance or contraindications, suggesting an opportunity for quality improvement.