ABSTRACT
IMPORTANCE: The benefit of an electronic support system for the prescription and adherence to oral anticoagulation therapy among patients with atrial fibrillation (AF) and atrial flutter at heightened risk for of stroke and systemic thromboembolism is unclear. OBJECTIVE: To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence. DESIGN, SETTING, AND PARTICIPANTS: A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system. EXPOSURES: An electronic support system comprising 1) an electronic alert to identify patients with AF or atrial flutter, a CHA2DS2-VASc score ≥ 2, and not on oral anticoagulation and 2) electronic shared decision-making tool to promote discussions between providers and patients regarding therapy. MAIN OUTCOMES AND MEASURES: The primary endpoint was prescription rate of anticoagulation therapy. The secondary endpoint was adherence to anticoagulation therapy defined as medication possession ratio ≥ 80% during the 12 months of follow-up. RESULTS: Between June 13, 2018 and August 31, 2018, the automated intervention identified and triggered a unique alert for 939 consecutive patients with AF or atrial flutter, a CHA2DS2-VASc score ≥2 who were not on oral anticoagulation. The median CHA2DS2-VASc score among all patients identified by the alert was 2 and the median untreated duration prior to the alert was 495 days (interquartile range 123 - 1,831 days). Of the patients identified by the alert, 345 (36.7%) initiated anticoagulation therapy and 594 (63.3%) did not: 68.7% were treated with a non-Vitamin K antagonist oral anticoagulant (NOAC), 22.0% with warfarin, and 9.3 % combination of NOAC and warfarin. Compared with historical anticoagulation rates, the electronic alert was associated with a 23.6% increase in anticoagulation prescriptions. The overall 1-year rate of adherence to anticoagulant therapy was 75.4% (260/345). CONCLUSION AND RELEVANCE: An electronic automated alert can successfully identify patients with AF and atrial flutter at high risk for stroke, increase oral anticoagulation prescription, and support high rates of adherence.
Subject(s)
Atrial Fibrillation , Stroke , Administration, Oral , Anticoagulants , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Electronics , Humans , Prospective Studies , Risk Assessment , Risk Factors , Stroke/chemically induced , Stroke/prevention & control , WarfarinABSTRACT
Objective To investigate the genotypes of aminoglycoside-modifying enzymes (AMEs) produced by Pseudomonas aeruginosa isolated from Huaibei Miner's General Hospital.Methods Minimum inhibitory concentration of 36 strains of P. aeruginosa to 3 aminoglycoside antibiotics was determined. AME genes were amplified by polymerase chain reaction (PCR). Results The P. aeruginosa isolates were resistant to multiple antibiotics. Most (62.2% to 81.1%) were resistant to aminoglycosides. And 27 strain (75.0%) carried one or more types of AME genes, including ant(3″)-Ⅰ (63.9%), aac(6')-Ⅱ (58.3%), aac(6')-Ⅰ (50.0%), aac(3)-Ⅱ (38.9%) and ant(2″)-Ⅰ (36.1%). The aac(3)-Ⅰ, aac(3)-Ⅲ, aac(3)-Ⅳ, aph(3')-Ⅳ genes were not identified.Conclusions The study indicates that the P. aeruginosa isolates in Huaibei are multi-resistant to aminoglycoside antibiotics. The prevalence of AMEs-positive strains is high.
ABSTRACT
Objective To investigate the action of integron-mediated multidrug resistance in clinical multi-resistant Pseudomonas aeruginosa in Huaibei area.Methods The antibiotic susceptibility of 13 different antibiotics of 36 multi-drug resistant P.aeruginosa was tested by K-B.The three-dimensional method was taken to differentiate the various beta-lactamases.The integron was determined by PCR with integron-specific primer.Results The positive rate of integron detection in multi-resistant Pseudomonas aeruginosa was 86.1%.Two kinds of integron with different length were found,i.e.1 000 bp and 2 000 bp.PSE-1,aadA2,aadB,aac(6)-II and CARB-8 were the resistance-related gene cassette in the integrons.Conclusions Integron may enroll in multiple resistance of multi-resistant Pseudomonas aeruginosa.
ABSTRACT
OBJECTIVE To investigate the genes associated with the drug-resistance to ?-lactam antibiotics in Pseudomonas aeruginosa(PAE) isolated from clinical patients in Huaibei,Anhui Province.METHODS Antibiotic sensitivity test was performed by VITEK-AMS.The three-dimensional method was taken to differentiate various beta-lactamases.The ?-lactamases and the outer membrane protein D2(oprD2) genes were detected by polymerase chain reaction(PCR) in 36 PAE strains.RESULTS In 36 PAE strains,the positive rates of genes of TEM,DHA,CTX-Ge and CARB were 77.8%,69.2%,27.8% and 25.0%,respectively,that of the OXA-1,OXA-10,VIM-2 and IMP-1 were 16.7%,16.7%,13.9% and 2.8%,respectively.The rate of lacking oprD2 gene was 58.3%,and none possessed VEB,SHV,GES,PER,GIM and SPM-2 genes.CONCLUSIONS P.aeruginosa carries various beta-lactamase genes in clinical patients of Huaibei,and the deletion ratio of oprD2 gene is higher.
