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Ladhani SN, Fernandes S, Garg M, Borrow R, de Lusignan S, Bolton-Maggs PHB. Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline. Br J Haematol 2024; 204:1672-1686. [PMID: 38600782 DOI: 10.1111/bjh.19361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 04/12/2024]
Abstract
Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non-infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti-microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.
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Affiliation(s)
- Shamez N Ladhani
- Centre for Neonatal and Paediatric Infections (CNPI), St. George's University of London, London, UK
- Immunisation and Countermeasures Division, UK Health Security Agency Colindale, London, UK
| | - Savio Fernandes
- Department of Haematology, Dudley Group Foundation NHS Trust, Russell's Hall Hospital, Dudley, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), University of Oxford, Oxford, UK
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Camp J, Bayrhuber M, Anka N, Heine V, Glattacker M, Farin-Glattacker E, Rieg S. Efficacy of a novel patient-focused intervention aimed at increasing adherence to guideline-based preventive measures in asplenic patients: the PrePSS trial. Infection 2023; 51:1787-1795. [PMID: 37653288 PMCID: PMC10665246 DOI: 10.1007/s15010-023-02088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To determine whether a novel intervention improves the adherence to guideline-based preventive measures in asplenic patients at risk of post-splenectomy sepsis (PSS). METHODS We used a prospective controlled, two-armed historical control group design to compare a novel, health action process approach (HAPA)-based telephonic intervention involving both patients and their general practitioners to usual care. Eligible patients were identified in cooperation with the insurance provider AOK Baden-Wuerttemberg, Germany. Patients with anatomic asplenia (n = 106) were prospectively enrolled and compared to a historical control group (n = 113). Comparisons were done using a propensity-score-based overlap-weighting model. Adherence to preventive measures was quantified by the study-specific 'Preventing PSS score' (PrePSS score) which includes pneumococcal and meningococcal vaccination status, the availability of a stand-by antibiotic and a medical alert card. RESULTS At six months after the intervention, we estimated an effect of 3.96 (95% CI 3.68-4.24) points on the PrePSS score scale (range 0-10) with mean PrePSS scores of 3.73 and 7.70 in control and intervention group, respectively. Substantial improvement was seen in all subcategories of the PrePSS score with the highest absolute gains in the availability of stand-by antibiotics. We graded the degree of participation by the general practitioner (no contact, short contact, full intervention) and noted that the observed effect was only marginally influenced by the degree of physician participation. CONCLUSIONS Patients who had received the intervention exhibited a significantly higher adherence to guideline-based preventive measures compared to the control group. These data suggest that widespread adoption of this pragmatic intervention may improve management of asplenic patients. Health insurance provider-initiated identification of at-risk patients combined with a patient-focused intervention may serve as a blueprint for a wide range of other preventive efforts leading to patient empowerment and ultimately to better adherence to standards of care.
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Affiliation(s)
- Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Marianne Bayrhuber
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natascha Anka
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Valerie Heine
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Orangzeb S, Watle SV, Caugant DA. Adherence to vaccination guidelines of patients with complete splenectomy in Norway, 2008-2020. Vaccine 2023:S0264-410X(23)00699-0. [PMID: 37336662 DOI: 10.1016/j.vaccine.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
The spleen is responsible for blood filtration and mounting an immune response against pathogens. In some people the spleen must be surgically removed because of traumatic events or oncological and hematological conditions. These patients are at higher risk of developing diseases caused by encapsulated bacteria throughout their lives. Thus, immunisations are advised for splenectomised persons to prevent infection caused by Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). This study assessed vaccination coverage (VC) among Norwegian patients with surgical asplenia. Using the Nomesco Classification of Surgical Procedures codes, patient information (age, sex, date of initial diagnosis and date of surgery) was acquired from the Norwegian Patient Registry. The National Immunization Register provided information on vaccination status and data of any subsequent invasive bacterial infections were obtained from the Norwegian Surveillance System for Communicable Diseases. From the total population of Norway, 3155 patients who had undergone complete splenectomy were identified. Of these, 914 (29.0%) had received at least one dose of pneumococcal conjugate vaccine (PCV), 1324 (42.0%) at least one dose of pneumococcal polysaccharide vaccine and 589 (18.7%) had received both. Only 4.2% of the patients had received two doses of a meningococcal ACWY conjugate vaccine, while 8.0% of 1467 patients splenectomised after 2014 had received at least two doses of a serogroup B meningococcal vaccine. The VC for Hib was 18.7%. Nearly all splenectomised children under the age of 10 were vaccinated with Hib and PCV as these vaccines are included in the childhood immunisation program. For all vaccines, VC decreased with age. Twenty-nine invasive bacterial infections were registered post-splenectomy in 25 patients. Vaccination according to national recommendations could have prevented at least 8 (28%) of these infections. Our study showed that efforts are required to increase VC of splenectomised individuals in Norway.
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Affiliation(s)
- Saima Orangzeb
- Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway; Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Sara Viksmoen Watle
- Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway; Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Dominique A Caugant
- Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway; Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway.
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Te Linde E, Doornekamp L, Daenen KCP, van Gorp ECM, Bruns AHW. Dutch Healthcare Professionals' Opinion on the Allocation of Responsibilities concerning Prescribing and Administering Medically Indicated Vaccines to Immunocompromised Patients. Vaccines (Basel) 2023; 11:vaccines11030686. [PMID: 36992271 DOI: 10.3390/vaccines11030686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Specific vaccines are indicated for immunocompromised patients (ICPs) due to their vulnerability to infections. Recommendation of these vaccines by healthcare professionals (HCPs) is a crucial facilitator for vaccine uptake. Unfortunately, the responsibilities to recommend and administer these vaccines are not clearly allocated among HCPs involved in the care of adult ICPs. We aimed to evaluate HCPs' opinions on directorship and their role in facilitating the uptake of medically indicated vaccines as a basis to improve vaccination practices. METHODS A cross-sectional survey was performed among in-hospital medical specialists (MSs), general practitioners (GPs), and public health specialists (PHSs) in the Netherlands to assess their opinion on directorship and the implementation of vaccination care. Additionally, perceived barriers, facilitators, and possible solutions to improve vaccine uptake were investigated. RESULTS In total, 306 HCPs completed the survey. HCPs almost unanimously (98%) reported that according to them, the primary treating physician is responsible for recommending medically indicated vaccines. Administering these vaccines was seen as a more shared responsibility. The most important barriers experienced by HCPs in recommending and administering were reimbursement problems, a lack of a national vaccination registration system, insufficient collaboration among HCPs, and logistical problems. MSs, GPs and PHSs all mentioned the same three solutions as important strategies to improve vaccination practices, i.e., reimbursement of vaccines, reliable and easily accessible registration of received vaccines, and arrangements for collaboration among the different HCPs that are involved in care. CONCLUSION The improvement in vaccination practices in ICPs should focus on better collaboration among MSs, GPs, and PHSs, who should know each other's expertise; clear agreement on responsibility; reimbursement for vaccines; and the availability of clear registration of vaccination history.
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Affiliation(s)
- Elsemieke Te Linde
- Department of Infectious Diseases, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Laura Doornekamp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Katrijn C P Daenen
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Anke H W Bruns
- Department of Infectious Diseases, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Anka N, Glattacker M, Farin-Glattacker E, Camp J, Rieg S, Bayrhuber M. Patients' with asplenia and doctors' experiences in implementing preventative measures following a novel educational intervention: a qualitative analysis. BMJ Open 2022; 12:e060492. [PMID: 36351729 PMCID: PMC9644314 DOI: 10.1136/bmjopen-2021-060492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To explore patients' with asplenia and general practitioners' (GPs) (1) perceptions of a novel, Health Action Process Approach (HAPA)-based, educational intervention which targets to increase adherence to post-splenectomy sepsis (PSS) prevention measures and (2) their experience in implementing prevention measures following this intervention. DESIGN A process evaluation conducted on average 3.5 (for patients) and 3.8 (for GPs) months after the intervention between January 2020 and April 2021 individually by means of semi-structured guideline-based telephone interviews. Data was analysed using qualitative content analysis. PARTICIPANTS Volunteer subsample of N=25 patients with asplenia and N=8 GPs who received the intervention. Inclusion criteria were met by prior participation in the intervention (German-speaking, of full age and insured by the cooperating health insurance). Patient selection was done by purposeful selection aiming at maximum variability in terms of adherence to preventative measures prior to intervention participation. Participating GPs are a non-purposeful selected convenience sample. For reasons of data protection, no personal data was collected. RESULTS The intervention was positively evaluated and its personal relevancy for patients and for the GPs' professional work became apparent. The intervention promoted risk awareness, intention to action, action planning and subsequently, improved adherence to preventative measures. Helpful factors for implementation among the patients were social support by relatives and GPs. Barriers to adherence identified in both groups can be divided into patient-attributed (eg, comorbidities), doctor-related (eg, lack of knowledge or support) as well as contextual factors (eg, vaccine supply constraints). CONCLUSIONS Our findings indicate a patient and GP perceived benefit of the intervention, but still identify prevailing barriers to implementation. In a further step, a quantitative evaluation of the intervention will be conducted and recommendations for integrating the intervention in usual care will be made. TRIAL REGISTRATION NUMBER DRKS00015238.
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Affiliation(s)
- Natascha Anka
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Marianne Bayrhuber
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Faculty of Medicine, Freiburg, Germany
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Hale AJ, Depo B, Khan S, Whitman TJ, Bullis S, Singh D, Peterson K, Hyson P, Catoe L, Tompkins BJ, Kemper Alston W, Dejace J. The Impact of Standardized Infectious Diseases Consultation on Post-Splenectomy Care and Outcomes. Open Forum Infect Dis 2022; 9:ofac380. [PMID: 35983262 PMCID: PMC9379811 DOI: 10.1093/ofid/ofac380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients who receive splenectomy are at risk for overwhelming postsplenectomy infection (OPSI). Guidelines recommend that adult asplenic patients receive a complement of vaccinations, education on the risks of OPSI, and on-demand antibiotics. However, prior literature suggests a majority of patients who have had a splenectomy receive incomplete asplenic patient care and thus remain at increased risk. This study assessed the impact of standardized involvement of infectious diseases (ID) providers on asplenic patient care outcomes in patients undergoing splenectomy.
Methods
A quasi-experimental study design compared a prospective cohort of patients undergoing splenectomy from August 2017 to June 2021 who received standardized ID involvement in care of the asplenic patient with a historic control cohort of patients undergoing splenectomy at the same institution from January 2010 through July 2017 who did not. There were 11 components of asplenic patient care defined as primary outcomes. Secondary outcomes included the occurrence of OPSI, death, and death from OPSI.
Results
50 patients were included in the prospective intervention cohort and 128 in the historic control cohort. There were significant improvements in 9 of the 11 primary outcomes in the intervention arm as compared to the historic controls. Survival analysis showed no statistically significant difference in the incidence of OPSI-free survival between the groups (p = 0.056), though there was a trend towards improvement in the prospective intervention arm.
Conclusions
Standardized involvement of an ID provider in the care of patients undergoing splenectomy improves asplenic patient care outcomes. Routine involvement of ID in this setting may be warranted.
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Affiliation(s)
- Andrew J Hale
- Infectious diseases physician at the University of Vermont Medical Center and Assistant Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - Benjamin Depo
- Internal medicine physician at the University of Vermont Medical Center and Assistant Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - Sundas Khan
- Hematology-Oncology fellow at Lankenau Medical Center , Wynnewood, PA , USA
| | - Timothy J Whitman
- Infectious diseases physician at the University of Vermont Medical Center and Associate Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - Sean Bullis
- Infectious diseases physician at the University of Vermont Medical Center and Assistant Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - Devika Singh
- Infectious diseases physician at the University of Vermont Medical Center and Assistant Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - Katherine Peterson
- Infectious diseases physician at the University of Vermont Medical Center and Assistant Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - Peter Hyson
- Infectious diseases fellow at the University of Vermont Medical Center , Burlington, VT , USA
| | - Laura Catoe
- Infectious diseases nurse practitioner at the University of Vermont Medical Center , Burlington, VT , USA
| | - Bradley J Tompkins
- Quality analyst for the Quality Program in the Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - W Kemper Alston
- Infectious diseases physician at the University of Vermont Medical Center and Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
| | - Jean Dejace
- Infectious diseases physician at the University of Vermont Medical Center and Assistant Professor of Medicine at Larner College of Medicine at the University of Vermont , Burlington, VT , USA
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Bianchi FP, Stefanizzi P, Spinelli G, Mascipinto S, Tafuri S. Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines 2021; 20:297-308. [PMID: 33538617 DOI: 10.1080/14760584.2021.1886085] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asplenic or splenectomized patients have a higher risk (ranging from 10 to 50-fold) than the general population of developing an overwhelming post-splenectomy infection (OPSI). Thus, they should receive specific vaccinations to prevent bacterial infections and influenza. The aim of this meta-analysis was to estimate vaccination coverage (VC) with the recommended vaccines among splenectomized patients; strategies recommended in those studies to improve VC worldwide are considered as well. RESEARCH DESIGN AND METHODS Scopus, MEDLINE/PubMed, Google Scholar and ISI Web of Knowledge databases were searched. Research papers, short reports, reviews, and meta-analyses published between January 1, 2010 and July 18, 2020 were included; no geographic restrictions were included. Twenty-four studies were included in the meta-analysis. RESULTS For anti-pneumococcal vaccination, coverage was 55.1% (95%CI = 41.0-69.2%), for anti-Hib 48.3% (95%CI = 34.3-52.3%), for anti-meningococcal C/ACYW135 33.7% (95%CI = 23.6-43.9%), for anti-meningococcal B 13.3% (95%CI = 7.0-19.5%) and for anti-influenza 53.2% (95%CI = 22.0-84.4%). Most studies determined a lack of adherence to international guidelines by healthcare workers and suggested the need to better educate health professionals in the management of post-splenectomy patients. CONCLUSIONS The meta-analysis showed the suboptimal immunization coverage for the vaccines recommended for asplenic patients. Greater efforts must be made by public health professionals to increase VC in this group of patients at risk. Introducing specific prophylaxis protocols in the clinical routine seems to guarantee better immunization compliance in those patients.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Giuseppe Spinelli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Simona Mascipinto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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Albelbeisi AH, Albelbeisi A, El Bilbeisi AH, Taleb M, Takian A, Akbari-Sari A. Barriers of Adherence among Palestinian Healthcare Professionals towards the Protocol of Health Education and Counselling on Healthy Behaviours for Non-Communicable Diseases. Ethiop J Health Sci 2021; 31:73-84. [PMID: 34158754 PMCID: PMC8188095 DOI: 10.4314/ejhs.v31i1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the huge numbers of the universally produced and employed protocols, the adherence with them is still low to moderate in the healthcare settings. This study was employed to assess the attitudes of Palestinian healthcare professionals in Gaza Strip to health education and counseling on healthy behaviours protocol (WHO-PEN Protocol 2), for patients with non-communicable diseases in the Ministry of Health primary healthcare centers. METHODS This cross-sectional study was conducted with a census sample of all governmental family physicians and nurses (n=175). The study questionnaire was developed based on Cabana theoretical framework. The Arabic version questionnaire was developed based on the cross-cultural adaptation framework. The psychometric properties of the Arabic version questionnaire was finally evaluated. RESULTS The psychometric properties of the Arabic version questionnaire showed good construct validity and internal consistency reliability. The overall adherence level to WHO-PEN Protocol 2 was 70.0, SD=6.9. The main perceived barriers were lack of incentive, patients' factors, and lack of time. In general, most of healthcare professional respondents had a positive attitude toward the protocol, but this attitude was not predictor to protocol adherence. CONCLUSION The good validity and reliability of the questionnaire can provide support for the accuracy of the study results. Varied implementation strategies targeting the major barriers derived from the study are extremely required for addressing the lack of incentives, patients' factors and time constraints.
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Affiliation(s)
- Ahmed Hassan Albelbeisi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
| | - Ali Albelbeisi
- In-service Health Education, European Gaza Hospital, Ministry of Health, Palestine
| | - Abdel Hamid El Bilbeisi
- Department of Clinical Nutrition, Faculty of Pharmacy, Al Azhar University of Gaza, Palestine
| | - Mahmoud Taleb
- Faculty of Pharmacy, Al Azhar University of Gaza, Palestine
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari-Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
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Lee GM. Preventing infections in children and adults with asplenia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:328-335. [PMID: 33275684 PMCID: PMC7727556 DOI: 10.1182/hematology.2020000117] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
An estimated 1 million people in the United States have functional or anatomic asplenia or hyposplenia. Infectious complications due to encapsulated organisms such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae can lead to fulminant sepsis and death, particularly in young children, in the period shortly after splenectomy, and in immunocompromised patients. Patients with asplenia are also at risk for less common infections due to Capnocytophaga, Babesia, and malaria. Antibiotic prophylaxis, vaccines, and patient and family education are the mainstays of prevention in these at-risk patients. Recommendations for antibiotic prophylaxis typically target high-risk periods, such as 1 to 3 years after splenectomy, children ≤5 years of age, or patients with concomitant immunocompromise. However, the risk for sepsis is lifelong, with infections occurring as late as 40 years after splenectomy. Currently available vaccines recommended for patients with asplenia include pneumococcal vaccines (13-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine), meningococcal vaccines (meningococcal conjugate vaccines for serogroups A, C, Y and W-135 and serogroup B meningococcal vaccines), H. influenzae type b vaccines, and inactivated influenza vaccines. Ongoing booster doses are also recommended for pneumococcal and meningococcal vaccines to maintain protection. Despite the availability of prevention tools, adherence is often a challenge. Dedicated teams or clinics focused on patient education and monitoring have demonstrated substantial improvements in vaccine coverage rates for individuals with asplenia and reduced risk of infection. Future efforts to monitor the quality of care in patients with asplenia may be important to bridge the know-do gap in this high-risk population.
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Affiliation(s)
- Grace M Lee
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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10
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Casciani F, Trudeau MT, Vollmer CM. Perioperative Immunization for Splenectomy and the Surgeon's Responsibility: A Review. JAMA Surg 2020; 155:1068-1077. [PMID: 32936229 DOI: 10.1001/jamasurg.2020.1463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Patients who have had splenectomy have a lifelong risk of overwhelming postsplenectomy infection (OPSI), a condition associated with high mortality rates. Surgeons must be aware of the rationale of vaccination in the case of splenectomy, to provide appropriate immunization in the perioperative time. Observations English-language articles published from January 1, 1990, to December 31, 2019, were retrieved from MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases. Randomized clinical trials as well as systematic reviews and observational studies were considered. Asplenia yields an impairment of both innate and adaptive immunity, thus increasing the risk of severe encapsulated bacterial infections. Current epidemiology of OPSI ranges from 0.1% to 8.5% but is hard to ascertain because of ongoing shifts in patients' baseline conditions and vaccine penetration. Despite the lack of randomized clinical trials, immunization appears to be effective in reducing OPSI incidence. Unfortunately, vaccination coverage is still suboptimal, with a great variability in vaccination rates being reported across institutions and time frames. Notably, current guidelines do not advocate any particular health care qualification responsible for vaccine prescription or administration. Given the dearth of high-level basic science or clinical evidence, the optimal vaccination timing and the need for booster doses are not yet well established. Although almost all guidelines indicate to not administer vaccines within 14 days before and after surgery, most data suggest that immunization might be effective even in the immediate perioperative time, thus placing the surgeon in a primary position for vaccine delivery. Furthermore, revaccination schedules are the target of ongoing debates, since a vaccine-driven hyporesponsiveness has been postulated. Conclusions and Relevance In patients who have undergone splenectomy, OPSI might be effectively prevented by proper immunization. Surgeons have the primary responsibility for achieving adequate, initial immunization in the setting of both planned and urgent splenectomy.
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Affiliation(s)
- Fabio Casciani
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Maxwell T Trudeau
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Charles M Vollmer
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
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Hong J, Chen J. Clinical Physicians' Attitudes towards Evidence-Based Medicine (EBM) and Their Evidence-Based Practice (EBP) in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193758. [PMID: 31591286 PMCID: PMC6801589 DOI: 10.3390/ijerph16193758] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022]
Abstract
Objective: Numerous studies have proved the importance of Evidence-Based Medicine (EBM) in daily clinical practice, however, clinicians’ attitudes play an important role in determining its implementation. The objective of this study was to investigate Chinese clinical physicians’ perception of and attitude towards EBM and their Evidence-Based Practice (EBP) as well as the barriers towards EBP. Methods: Using a cross-sectional design, self-response questionnaires were distributed to clinical physicians (internal medicine and surgery departments) across three tertiary hospitals in Wuhan, China. Results: In total, 131 out of 195 (67.2%) physicians completed and returned the questionnaire. A total of 64.9% of the physicians either knew moderately or a lot about EBM. The mean score of physicians’ attitude toward EBM was 2.35 ± 0.35, and that of their EBP skill/ competency was 1.51 ± 0.56 (on 0–3 Likert scale). In total, 76.0% of physicians often or sometimes applied EBM in routine daily practice. The largest barrier preventing implementation was the varying individual differences in diseases (61.0%), followed by a lack of investment from the hospital/department (39.8%), and a lack of patient cooperation (37.4%). Chinese physicians in tertiary hospitals possessed expressed positive attitudes towards EBM; however, they only retained a moderate level of clinical evidence competency. Both an individual factor (personal interest) and organizational factors (workload, hospital requirement) had an effect on physicians’ attitudes and their EBP skills. Management and organizational efforts, in addition to time dedicated for EBP projects could help reduce barriers that prevent EBP.
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Affiliation(s)
- Jianan Hong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430000, China.
| | - Jing Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430000, China.
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Di Sabatino A, Lenti MV, Tinozzi FP, Lanave M, Aquino I, Klersy C, Marone P, Marena C, Pietrabissa A, Corazza GR. Vaccination coverage and mortality after splenectomy: results from an Italian single-centre study. Intern Emerg Med 2017; 12:1139-1147. [PMID: 28799083 DOI: 10.1007/s11739-017-1730-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/04/2017] [Indexed: 02/06/2023]
Abstract
Splenectomy is a well-recognised risk factor for life-threatening overwhelming post-splenectomy infection (OPSI). To prevent OPSI, immunisations against encapsulated bacteria (S. pneumoniae, N. meningitidis, H. influenzae) and influenza virus are recommended. However, there is still a lack of uniformity and poor compliance with these recommendations. Following a local physicians' awareness campaign regarding the importance of vaccine prophylaxis of splenectomised patients, we aimed to register vaccination coverage, mortality and infection rates in all patients who underwent splenectomy at our hospital, over a six-year time span. Reasons for splenectomy, patients' compliance with vaccinations, mortality and infectious events were recorded. The reasons for splenectomy in the 216 identified patients (mean age 58.2 ± 14; M:F ratio 1.4:1) were haematologic disorders (38.8%), solid tumours (28.7%), traumatic rupture (22.7%) and other causes (9.7%). A total of 146 patients (67.6%) received at least one of the four vaccines. Overall, the mortality rate was significantly greater in unvaccinated compared to vaccinated patients (p < 0.001), although after the adjustment for the cause of splenectomy the statistical significance was lost (p = 0.085) due to the burden of solid tumour-related mortality. Among the 21 reported cases of OPSI, eight were fatal and five were potentially vaccine-preventable. Our results show that two-thirds of splenectomised patients comply with vaccine prophylaxis. Future interventional studies or ad hoc registries might overcome barriers to vaccination or intentional non-compliance.
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Affiliation(s)
- Antonio Di Sabatino
- First Department of Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
- Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Marco Vincenzo Lenti
- First Department of Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Marina Lanave
- Biometry and Clinical Epidemiology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Ivana Aquino
- Department of Preventive Medicine, ASL Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Piero Marone
- Department of Infectious Diseases, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Carlo Marena
- Biometry and Clinical Epidemiology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Andrea Pietrabissa
- Department of Surgery, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Rousseau L, Kerforne T, Boisson M, Mimoz O, Dahyot-Fizelier C. Perioperative management of asplenic patients in France: A national survey among anaesthetists. Anaesth Crit Care Pain Med 2017; 36:359-363. [PMID: 28870849 DOI: 10.1016/j.accpm.2017.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 04/23/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Ludivine Rousseau
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
| | - Thomas Kerforne
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1082, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Matthieu Boisson
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1070, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Olivier Mimoz
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1070, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1070, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Struijk G, Lammers A, Brinkman R, Lombarts M, van Vugt M, van der Pant K, ten Berge I, Bemelman F. Immunization after renal transplantation: current clinical practice. Transpl Infect Dis 2015; 17:192-200. [DOI: 10.1111/tid.12368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/30/2014] [Accepted: 02/01/2015] [Indexed: 01/22/2023]
Affiliation(s)
- G.H. Struijk
- Renal Transplant Unit; Department of Nephrology; Division of Internal Medicine; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - A.J.J. Lammers
- Department of Infectious Diseases, Tropical Medicine and AIDS; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - R.J. Brinkman
- Renal Transplant Unit; Department of Nephrology; Division of Internal Medicine; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - M.J.M.H. Lombarts
- Professional Performance Research Group; Center of Evidence-Based Education; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - M. van Vugt
- Department of Infectious Diseases, Tropical Medicine and AIDS; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - K.A.M.I. van der Pant
- Renal Transplant Unit; Department of Nephrology; Division of Internal Medicine; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - I.J.M. ten Berge
- Renal Transplant Unit; Department of Nephrology; Division of Internal Medicine; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - F.J. Bemelman
- Renal Transplant Unit; Department of Nephrology; Division of Internal Medicine; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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Graf A, Jones P, Cheng AC, Leder K. Healthcare provider knowledge, attitudes and practices in patients on the Victorian Spleen Registry. Aust N Z J Public Health 2014; 38:560-2. [PMID: 25308303 DOI: 10.1111/1753-6405.12242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/01/2014] [Accepted: 02/01/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the knowledge, attitudes and practices of healthcare providers regarding asplenic patients and to assess their satisfaction with the Victorian Spleen Registry (VSR) service. METHODS Survey forms were sent to 992 healthcare providers listed as caring for at least one patient registered on the VSR. RESULTS A total of 223 completed questionnaires were returned. Healthcare providers heard about the VSR mainly from another healthcare professional or through a healthcare institution (31.7%), via online or printed resources (30.8%) or from their patients (24.4%). Most respondents valued the work of the VSR in providing information to healthcare professionals (71.4%), providing a reminder service for vaccinations (66.7%) and providing education to patients (60.5%). Most of those surveyed correctly identified high-risk infections for asplenic and hyposplenic patients with encapsulated organisms, but less than one-third identified a risk with malarial infections (32.9%). Providers always recommended influenza vaccinations, emergency standby antibiotics and an alert medallion or card in 92.8%, 63.6% and 36.4% of cases, respectively. CONCLUSIONS Healthcare providers value and are satisfied with the service provided by the VSR. Patients can play a valuable role in communicating with their health providers. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. IMPLICATIONS The results positively reflect the functioning of the VSR, although better promotion of the VSR among healthcare professionals and consideration of expansion is needed.
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Affiliation(s)
- Anneke Graf
- Victorian Spleen Registry, Infectious Diseases Unit, The Alfred Hospital, Victoria
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16
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Tian N, Liu Z, Yang M, Li Z, Zhang G, Han Q, Li N, Zhu Q, Lv Y, Wang Y, Xing F. Effect of antiviral therapy on the survival and incidence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension. Virol J 2012; 9:273. [PMID: 23158807 PMCID: PMC3546857 DOI: 10.1186/1743-422x-9-273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 11/14/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Splenectomy remains a common approach for the management of hypersplenism and portal hypertension in hepatitis B virus (HBV)-associated cirrhotic patients in China and some other Asian countries. The effects of antiviral therapy on the survival and occurrence of complications in asplenic HBV-associated cirrhotic patients are unknown. This study analyzed the effect of antiviral therapy on survival and occurrence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension. RESULTS Of the 57 eligible patients for analysis, 28 patients received nucleos(t)ide analogs (treatment group) for antiviral treatment after splenectomy, while 29 patients received no antiviral treatment (control group). After a median of 3 years and 9 months, the overall survival and complication-free survival in the treatment group were higher though not statistically significant than those in the control group. Multivariate analysis showed that antiviral treatment was associated with increased but not statistically significant overall survival (hazard ratio (HR): 2.272, 95% confidence interval (CI): 0.952-5.424, P=0.064) and the antiviral treatment was significantly associated with increased complication-free survival of the patients (HR: 7.229, 95% CI: 1.271-41.117, P=0.026). The complication-free survival in patients aged ≤ 40 years was higher than that in patients aged>40 years in the antiviral treatment patients (P=0.020). CONCLUSIONS Antiviral therapy initiating after splenectomy may reduce the incidence of complications and tend to improve the survival in asplenic HBV-associated cirrhotic patients, especially in younger patients, supporting the use of antiviral therapy in these patients after splenectomy.
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Affiliation(s)
- Ningqiang Tian
- Department of Infectious Diseases, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, No, 277 Yanta West Road, Xi' an, 710061, Shaanxi, China
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