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Lau BD, Shaffer DL, Kraus PS, Owodunni OP, Kia MV, Chiochetti SJ, Streiff MB, Haut ER. Prevention of Hospital-Associated Venous Thromboembolism: A Road Map to Defect-Free Care. Qual Manag Health Care 2023; 32:281-282. [PMID: 37651594 PMCID: PMC10543538 DOI: 10.1097/qmh.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Brandyn D Lau
- Russell H. Morgan Department of Radiology and Radiological Science (Mr Lau), Division of Acute Care Surgery, Department of Surgery (Ms Shaffer and Drs Chiochetti and Haut), Division of Hematology, Department of Medicine (Dr Streiff), Department of Anesthesiology and Critical Care Medicine (Dr Haut), and Department of Emergency Medicine (Dr Haut), The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland (Mr Lau and Drs Streiff and Haut); Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Mr Lau and Dr Haut); Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland (Dr Kraus); Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque (Dr Owodunni); and Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, Florida (Ms Kia)
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Haut ER, Owodunni OP, Wang J, Shaffer DL, Hobson DB, Yenokyan G, Kraus PS, Farrow NE, Canner JK, Florecki KL, Webster KLW, Holzmueller CG, Aboagye JK, Popoola VO, Kia MV, Pronovost PJ, Streiff MB, Lau BD. Alert-Triggered Patient Education Versus Nurse Feedback for Nonadministered Venous Thromboembolism Prophylaxis Doses: A Cluster-Randomized Controlled Trial. J Am Heart Assoc 2022; 11:e027119. [PMID: 36047732 DOI: 10.1161/jaha.122.027119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Many hospitalized patients are not administered prescribed doses of pharmacologic venous thromboembolism prophylaxis. Methods and Results In this cluster-randomized controlled trial, all adult non-intensive care units (10 medical, 6 surgical) in 1 academic hospital were randomized to either a real-time, electronic alert-triggered, patient-centered education bundle intervention or nurse feedback intervention to evaluate their effectiveness for reducing nonadministration of venous thromboembolism prophylaxis. Primary outcome was the proportion of nonadministered doses of prescribed pharmacologic prophylaxis. Secondary outcomes were proportions of nonadministered doses stratified by nonadministration reasons (patient refusal, other). To test our primary hypothesis that both interventions would reduce nonadministration, we compared outcomes pre- versus postintervention within each cohort. Secondary hypotheses were tested comparing the effectiveness between cohorts. Of 11 098 patient visits, overall dose nonadministration declined significantly after the interventions (13.4% versus 9.2%; odds ratio [OR], 0.64 [95% CI, 0.57-0.71]). Nonadministration decreased significantly (P<0.001) in both arms: patient-centered education bundle, 12.2% versus 7.4% (OR, 0.56 [95% CI, 0.48-0.66]), and nurse feedback, 14.7% versus 11.2% (OR, 0.72 [95% CI, 0.62-0.84]). Patient refusal decreased significantly in both arms: patient-centered education bundle, 7.3% versus 3.7% (OR, 0.46 [95% CI, 0.37-0.58]), and nurse feedback, 9.5% versus 7.1% (OR, 0.71 [95% CI, 0.59-0.86]). No differential effect occurred on medical versus surgical units. The patient-centered education bundle was significantly more effective in reducing all nonadministered (P=0.03) and refused doses (P=0.003) compared with nurse feedback (OR, 1.28 [95% CI, 1.0-1.61]; P=0.03 for interaction). Conclusions Information technology strategies like the alert-triggered, targeted patient-centered education bundle, and nurse-focused audit and feedback can improve venous thromboembolism prophylaxis administration. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03367364.
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Affiliation(s)
- Elliott R Haut
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD.,Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Surgery Center for Outcomes Research Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | | | - Jiangxia Wang
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Dauryne L Shaffer
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Department of Nursing The Johns Hopkins Hospital Baltimore MD
| | - Deborah B Hobson
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Nursing The Johns Hopkins Hospital Baltimore MD
| | - Gayane Yenokyan
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Peggy S Kraus
- Department of Pharmacy The Johns Hopkins Hospital Baltimore MD
| | - Norma E Farrow
- Department of Surgery Duke University Medical Center Durham NC
| | - Joseph K Canner
- The Johns Hopkins Surgery Center for Outcomes Research Johns Hopkins University School of Medicine Baltimore MD
| | | | - Kristen L W Webster
- Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Christine G Holzmueller
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD
| | - Jonathan K Aboagye
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD
| | - Victor O Popoola
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Mujan Varasteh Kia
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD
| | - Peter J Pronovost
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Michael B Streiff
- Division of Hematology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD
| | - Brandyn D Lau
- Division of Health Sciences Informatics, Russell H. Morgan Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD
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3
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Owodunni OP, Lau BD, Wang J, Shaffer DL, Kraus PS, Holzmueller CG, Aboagye JK, Hobson DB, Varasteh Kia M, Armocida S, Streiff MB, Haut ER. Effectiveness of a Patient Education Bundle on Venous Thromboembolism Prophylaxis Administration by Sex. J Surg Res 2022; 280:151-162. [PMID: 35969933 DOI: 10.1016/j.jss.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a frequent cause of preventable harm among hospitalized patients. Many prescribed prophylaxis doses are not administered despite supporting evidence. We previously demonstrated a patient-centered education bundle improved VTE prophylaxis administration broadly; however, patient-specific factors driving nonadministration are unclear. We examine the effects of the education bundle on missed doses of VTE prophylaxis by sex. METHODS We performed a post-hoc analysis of a nonrandomized controlled trial to evaluate the differences in missed doses by sex. Pre-intervention and intervention periods for patients admitted to 16 surgical and medical floors between 10/2014-03/2015 (pre-intervention) and 04/2015-12/2015 (intervention) were compared. We examined the conditional odds of (1) overall missed doses, (2) missed doses due to patient refusal, and (3) missed doses for other reasons. RESULTS Overall, 16,865 patients were included (pre-intervention 6853, intervention 10,012), with 2350 male and 2460 female patients (intervention), and 6373 male and 5682 female patients (control). Any missed dose significantly reduced on the intervention floors among male (odds ratio OR 0.55; 95% confidence interval CI, 0.44-0.70, P < 0.001) and female (OR 0.59; 95% CI, 0.47-0.73, P < 0.001) patients. Similar significant reductions ensued for missed doses due to patient refusal (P < 0.001). Overall, there were no sex-specific differences (P-interaction >0.05). CONCLUSIONS Our intervention increased VTE prophylaxis administration for both female and male patients, driven by decreased patient refusal. Patient education should be applicable to a wide range of patient demographics representative of the target group. To improve future interventions, quality improvement efforts should be evaluated based on patient demographics and drivers of differences in care.
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Affiliation(s)
- Oluwafemi P Owodunni
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dauryne L Shaffer
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Peggy S Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christine G Holzmueller
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland
| | - Jonathan K Aboagye
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah B Hobson
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mujan Varasteh Kia
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Armocida
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael B Streiff
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Xu J, Barone S, Varasteh Kia M, Holliday LS, Zahedi K, Soleimani M. Identification of IQGAP1 as a SLC26A4 (Pendrin)-Binding Protein in the Kidney. Front Mol Biosci 2022; 9:874186. [PMID: 35601831 PMCID: PMC9117723 DOI: 10.3389/fmolb.2022.874186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Several members of the SLC26A family of transporters, including SLC26A3 (DRA), SLC26A5 (prestin), SLC26A6 (PAT-1; CFEX) and SLC26A9, form multi-protein complexes with a number of molecules (e.g., cytoskeletal proteins, anchoring or adaptor proteins, cystic fibrosis transmembrane conductance regulator, and protein kinases). These interactions provide regulatory signals for these molecules. However, the identity of proteins that interact with the Cl-/HCO3 - exchanger, SLC26A4 (pendrin), have yet to be determined. The purpose of this study is to identify the protein(s) that interact with pendrin. Methods: A yeast two hybrid (Y2H) system was employed to screen a mouse kidney cDNA library using the C-terminal fragment of SLC26A4 as bait. Immunofluorescence microscopic examination of kidney sections, as well as co-immunoprecipitation assays, were performed using affinity purified antibodies and kidney protein extracts to confirm the co-localization and interaction of pendrin and the identified binding partners. Co-expression studies were carried out in cultured cells to examine the effect of binding partners on pendrin trafficking and activity. Results: The Y2H studies identified IQ motif-containing GTPase-activating protein 1 (IQGAP1) as a protein that binds to SLC26A4's C-terminus. Co-immunoprecipitation experiments using affinity purified anti-IQGAP1 antibodies followed by western blot analysis of kidney protein eluates using pendrin-specific antibodies confirmed the interaction of pendrin and IQGAP1. Immunofluorescence microscopy studies demonstrated that IQGAP1 co-localizes with pendrin on the apical membrane of B-intercalated cells, whereas it shows basolateral expression in A-intercalated cells in the cortical collecting duct (CCD). Functional and confocal studies in HEK-293 cells, as well as confocal studies in MDCK cells, demonstrated that the co-transfection of pendrin and IQGAP1 shows strong co-localization of the two molecules on the plasma membrane along with enhanced Cl-/HCO3 - exchanger activity. Conclusion: IQGAP1 was identified as a protein that binds to the C-terminus of pendrin in B-intercalated cells. IQGAP1 co-localized with pendrin on the apical membrane of B-intercalated cells. Co-expression of IQGAP1 with pendrin resulted in strong co-localization of the two molecules and increased the activity of pendrin in the plasma membrane in cultured cells. We propose that pendrin's interaction with IQGAP1 may play a critical role in the regulation of CCD function and physiology, and that disruption of this interaction could contribute to altered pendrin trafficking and/or activity in pathophysiologic states.
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Affiliation(s)
- Jie Xu
- Research Services, VA Medical Center, Albuquerque, NM, United States,Department of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Sharon Barone
- Research Services, VA Medical Center, Albuquerque, NM, United States,Department of Medicine, University of Cincinnati, Cincinnati, OH, United States,Department of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Mujan Varasteh Kia
- Department of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - L. Shannon Holliday
- Department of Orthodontics, University of Florida, Gainesville, FL, United States
| | - Kamyar Zahedi
- Research Services, VA Medical Center, Albuquerque, NM, United States,Department of Medicine, University of Cincinnati, Cincinnati, OH, United States,Department of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Manoocher Soleimani
- Research Services, VA Medical Center, Albuquerque, NM, United States,Department of Medicine, University of Cincinnati, Cincinnati, OH, United States,Department of Medicine, University of New Mexico, Albuquerque, NM, United States,*Correspondence: Manoocher Soleimani,
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Eisenson DL, Owodunni OP, Lau BD, Kia MV, Kraus PS, Holzmueller CG, Shaffer DL, Streiff MB, Haut ER. Prevalence and consequences of empiric anticoagulation for venous thromboembolism in patients hospitalized for COVID-19: a cautionary tale. J Thromb Thrombolysis 2021; 52:1056-1060. [PMID: 33939101 PMCID: PMC8091642 DOI: 10.1007/s11239-021-02471-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Brandyn D Lau
- Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA.,Division of Health Sciences Informatics, Baltimore, MD, USA.,The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Sheikh Zayed 6107C, 1800 Orleans St, Baltimore, MD, 21287, USA.,Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mujan Varasteh Kia
- Division of Acute Care Surgery, Department of Surgery, Baltimore, MD, USA
| | | | - Christine G Holzmueller
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Sheikh Zayed 6107C, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Dauryne L Shaffer
- Department of Surgery, Baltimore, MD, USA.,Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, Baltimore, MD, USA.,The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Sheikh Zayed 6107C, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, Baltimore, MD, USA. .,Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA. .,Department of Emergency Medicine, Baltimore, MD, USA. .,The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Sheikh Zayed 6107C, 1800 Orleans St, Baltimore, MD, 21287, USA. .,Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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6
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Varasteh Kia M, Lau BD, Owodunni OP, Kraus PS, Holzmueller CG, Hobson DB, Shaffer DL, Streiff MB, Haut ER. Nonadministration of pharmacologic venous thromboembolism prophylaxis is less common in hospitalized patients with COVID-19. J Thromb Thrombolysis 2021; 52:471-475. [PMID: 33507453 PMCID: PMC7840619 DOI: 10.1007/s11239-021-02384-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 12/28/2022]
Abstract
Introduction The incidence of venous thromboembolism (VTE) in patients hospitalized with COVID-19 is higher than most other hospitalized patients. Nonadministration of pharmacologic VTE prophylaxis is common and is associated with VTE events. Our objective was to determine whether nonadministration of pharmacologic VTE prophylaxis is more common in patients with COVID-19 versus other hospitalized patients. Materials and methods In this retrospective cohort analysis of all adult patients discharged from the Johns hopkins hospital between Mar 1 and May 12, 2020, we compared demographic, clinical characteristics, VTE outcomes, prescription and administration of VTE prophylaxis between COVID-19 positive, negative, and not tested groups. Results Patients tested positive for COVID-19 were significantly older, and more likely to be Hispanic, have a higher median body mass index, have longer hospital length of stay, require mechanical ventilation, develop pulmonary embolism and die (all p < 0.001). COVID-19 patients were more likely to be prescribed (aOR 1.51, 95% CI 1.38–1.66) and receive all doses of prescribed pharmacologic VTE prophylaxis (aOR 1.48, 95% CI 1.36–1.62). The number of patients who missed at least one dose of VTE prophylaxis and developed VTE was similar between the three groups (p = 0.31). Conclusions It is unlikely that high rates of VTE in COVID-19 are due to nonadministration of doses of pharmacologic prophylaxis. Hence, we should prioritize research into alternative approaches to optimizing VTE prevention in patients with COVID-19.
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Affiliation(s)
- Mujan Varasteh Kia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Brandyn D. Lau
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Oluwafemi P. Owodunni
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Peggy S. Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD USA
| | - Christine G. Holzmueller
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
| | - Deborah B. Hobson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD USA
| | - Dauryne L. Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD USA
| | - Michael B. Streiff
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Elliott R. Haut
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Sheikh Zayed 6107C, 1800 Orleans St., Baltimore, MD 21287 USA
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Owodunni OP, Lau BD, Shaffer DL, McQuigg D, Samuel D, Kantsiper M, Harris JE, Hobson DB, Kraus PS, Webster KLW, Holzmueller CG, Kia MV, Streiff MB, Haut ER. Disseminating a patient-centered education bundle to reduce missed doses of pharmacologic venous thromboembolism (VTE) prophylaxis to a community hospital. Journal of Patient Safety and Risk Management 2020. [DOI: 10.1177/2516043520969324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Venous thromboembolism (VTE) is a leading cause of preventable harm in hospitalized patients. However, many doses of prescribed pharmacologic VTE prophylaxis are frequently missed. We investigated the effect of a patient-centered education bundle on missed doses of VTE prophylaxis in a community hospital. Methods We performed a pre-post analysis examining missed doses of VTE prophylaxis in a community hospital. A real-time alert from the electronic health record system facilitated the delivery of a patient education bundle intervention. We included all patient visits on a single floor where at least 1 dose of VTE prophylaxis was prescribed during pre- (January 1, 2018, - November 31, 2018) and post- (January 1 - June 31, 2019) intervention periods. Outcomes included any missed dose (primary) and reasons for missed doses (refusal, other [secondary]) and were compared between both periods. Results 1,614 patient visits were included. The proportion of any missed dose significantly decreased (13.8% vs. 8.2% [OR, 0.56; 95% CI, 0.48, 0.64]) between the pre-post intervention periods. Patient refusal was the most frequent reason for missed doses. In the post-intervention period, patient refusal significantly decreased from 8.8% to 5.0% (OR, 0.54; 95% CI, 0.46, 0.64). Similarly, other reasons for missed doses significantly decreased from 5.0% to 3.2% (OR, 0.62; 95% CI, 0.51, 0.77). Conclusions A real-time alert-triggered patient-centered education bundle developed and tested in an academic hospital, significantly reduced missed doses of prescribed pharmacologic VTE prophylaxis when disseminated to a community hospital.
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Affiliation(s)
- Oluwafemi P Owodunni
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brandyn D Lau
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, USA
- Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Dauryne L Shaffer
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, USA
| | - Danielle McQuigg
- Howard County General Hospital, Johns Hopkins Medicine, Baltimore, USA
| | - Deborah Samuel
- Howard County General Hospital, Johns Hopkins Medicine, Baltimore, USA
| | - Mindy Kantsiper
- Howard County General Hospital, Johns Hopkins Medicine, Baltimore, USA
| | - James E Harris
- Howard County General Hospital, Johns Hopkins Medicine, Baltimore, USA
| | - Deborah B Hobson
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, USA
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, USA
| | - Peggy S Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, USA
| | - Kristen LW Webster
- Process Improvement Department, University of Louisville, Louisville, USA
| | - Christine G Holzmueller
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, USA
| | - Mujan Varasteh Kia
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Michael B Streiff
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, USA
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Elliott R Haut
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA Baltimore, USA
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8
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Soleimani M, Kia MV, Barone S, Brooks M, Zahedi K. Carbonic Anhydrase II Deletion Confers Salt Appetite and Elicits Adaptive Regulation of Salt and Water Transporters in the Kidney. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.533.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manoocher Soleimani
- Research ServicesVeterans AdministrationCincinnatiOH
- University of CincinnatiCincinnatiOH
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Miyazaki D, Matthews CA, Kia MV, El Haraki AS, Miyazaki N, Chen CCG. Validation of an educational simulation model for vaginal hysterectomy training: a pilot study. Int Urogynecol J 2018; 30:1329-1336. [PMID: 30191250 DOI: 10.1007/s00192-018-3761-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/22/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Miya Model ™ (Miyazaki Enterprises, Winston-Salem, NC, USA) was designed as a realistic vaginal surgery simulation model. Our aim was to describe this model and present pilot data on validity and reliability of the model as an assessment tool of vaginal hysterectomy skills. METHODS We video recorded ten obstetrics and gynecology residents (novice group) and ten practicing gynecologists (expert group) performing vaginal hysterectomy using the Miya model. Blood loss and time taken to complete the procedure were documented. Participants evaluated the model using a postsimulation survey. In addition, two experienced gynecologic surgeons independently evaluated video recordings of each participant's performance using two previously validated global rating scales: Reznick's Objective Structured Assessment of Technical Skill (OSATS) and Vaginal Surgical Skills Index (VSSI). RESULTS Most participants (80% of novice and 100% of expert group) rated the model as effective or highly effective for vaginal hysterectomy training and assessment. Median time to procedure completion was significantly higher in the novice group, whereas median estimated blood loss was no different between groups. No significant differences were observed in the composite median OSATS or VSSI scores between groups. The interrater reliability indices for subscales and composite scores of the OSATS and VSSI were high and ranged from 0.79 to 0.90 and 0.77 to 0.93, respectively. CONCLUSIONS With further study, the Miya Model may be a useful tool for teaching and assessing vaginal surgical skills.
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Affiliation(s)
- Douglas Miyazaki
- Woman Care, Novant Health, Department of Obstetrics and Gynecology, Wake Forest School of Medicine, 114 Charlois Blvd, Winston-Salem, NC, 27103, USA.
| | - Catherine A Matthews
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Mujan Varasteh Kia
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amr Sherif El Haraki
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Noah Miyazaki
- Associated Arts, Forsyth Technical College, Winston-Salem, NC, USA
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Varasteh Kia M, Barone S, McDonough AA, Zahedi K, Xu J, Soleimani M. Downregulation of the Cl-/HCO3-Exchanger Pendrin in Kidneys of Mice with Cystic Fibrosis: Role in the Pathogenesis of Metabolic Alkalosis. Cell Physiol Biochem 2018; 45:1551-1565. [PMID: 29482189 DOI: 10.1159/000487691] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Patients with cystic fibrosis (CF) are prone to the development of metabolic alkalosis; however, the pathogenesis of this life threatening derangement remains unknown. We hypothesized that altered acid base transport machinery in the kidney collecting duct underlies the mechanism of impaired bicarbonate elimination in the CF kidney. METHODS Balance studies in metabolic cages were performed in WT and CFTR knockout (CF) mice with the intestinal rescue in response to bicarbonate loading or salt restriction, and the expression levels and cellular distribution of acid base and electrolyte transporters in the proximal tubule, collecting duct and small intestine were examined by western blots, northern blots and/or immunofluorescence labeling. RESULTS Baseline parameters, including acid-base and systemic vascular volume status were comparable in WT and CF mice, as determined by blood gas, kidney renin expression and urine chloride excretion. Compared with WT animals, CF mice demonstrated a significantly higher serum HCO3- concentration (22.63 in WT vs. 26.83 mEq/l in CF mice; n=4, p=0.013) and serum pH (7.33 in WT vs. 7.42 in CF mice; n=4, p=0.00792) and exhibited impaired kidney HCO3- excretion (urine pH 8.10 in WT vs. 7.35 in CF mice; n=7, p=0.00990) following a 3-day oral bicarbonate load. When subjected to salt restriction, CF mice developed a significantly higher serum HCO3- concentration vs. WT animals (29.26 mEq/L in CF mice vs. 26.72 in WT; n=5, p=0.0291). Immunofluorescence labeling demonstrated a profound reduction in the apical expression of the Cl-/HCO3- exchanger pendrin in cortical collecting duct cells and western and northern blots indicated diminished plasma membrane abundance and mRNA expression of pendrin in CF kidneys. CONCLUSIONS We propose that patients with cystic fibrosis are prone to the development of metabolic alkalosis secondary to the inactivation of the bicarbonate secreting transporter pendrin, specifically during volume depletion, which is a common occurrence in CF patients.
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