Characterizing Patients Presenting on Hospital Admission With Central Line-Associated Bloodstream Infections: A Multicenter Study.

BACKGROUND: There are no systematic measures of central line-associated bloodstream infections (CLABSIs) in patients maintaining central venous catheters (CVCs) outside acute care hospitals. To clarify the burden of CLABSIs in these patients, we characterized patients with CLABSI present on hospital admission (POA). METHODS: Retrospective cross-sectional analysis of patients with CLABSI-POA in 3 health systems covering 11 hospitals across Maryland, Washington DC, and Missouri from November 2020 to October 2021. CLABSI-POA was defined using an adaptation of the acute care CLABSI definition. Patient demographics, clinical characteristics, and outcomes were collected via record review. Cox proportional hazard analysis was used to assess factors associated with the all-cause mortality rate within 30 days. RESULTS: A total of 461 patients were identified as having CLABSI-POA. CVCs were most commonly maintained in home infusion therapy (32.8%) or oncology clinics (31.2%). Enterobacterales were the most common etiologic agent (29.2%). Recurrent CLABSIs occurred in a quarter of patients (25%). Eleven percent of patients died during the hospital admission. Among patients with CLABSI-POA, mortality risk increased with age (hazard ratio vs age <20 years by age group: 20-44 years, 11.2 [95% confidence interval, 1.46-86.22]; 45-64 years, 20.88 [2.84-153.58]; ≥65 years, 22.50 [2.98-169.93]) and lack of insurance (2.46 [1.08-5.59]), and it decreased with CVC removal (0.57 [.39-.84]). CONCLUSIONS: CLABSI-POA is associated with significant in-hospital mortality risk. Surveillance is required to understand the burden of CLABSI in the community to identify targets for CLABSI prevention initiatives outside acute care settings.

Understanding the role of antibiotic-associated adverse events in influencing antibiotic decision-making.

Objective: To (1) understand the role of antibiotic-associated adverse events (ABX-AEs) on antibiotic decision-making, (2) understand clinician preferences for ABX-AE feedback, and (3) identify ABX-AEs of greatest clinical concern. Design: Focus groups. Setting: Academic medical center. Participants: Medical and surgical house staff, attending physicians, and advanced practice practitioners. Methods: Focus groups were conducted from May 2022 to December 2022. Participants discussed the role of ABX-AEs in antibiotic decision-making and feedback preferences and evaluated the prespecified categorization of ABX-AEs based on degree of clinical concern. Thematic analysis was conducted using inductive coding. Results: Four focus groups were conducted (n = 15). Six themes were identified. (1) ABX-AE risks during initial prescribing influence the antibiotic prescribed rather than the decision of whether to prescribe. (2) The occurrence of an ABX-AE leads to reassessment of the clinical indication for antibiotic therapy. (3) The impact of an ABX-AE on other management decisions is as important as the direct harm of the ABX-AE. (4) ABX-AEs may be overlooked because of limited feedback regarding the occurrence of ABX-AEs. (5) Clinicians are receptive to feedback regarding ABX-AEs but are concerned about it being punitive. (6) Feedback must be curated to prevent clinicians from being overwhelmed with data. Clinicians generally agreed with the prespecified categorizations of ABX-AEs by degree of clinical concern. Conclusions: The themes identified and assessment of ABX-AEs of greatest clinical concern may inform antibiotic stewardship initiatives that incorporate reporting of ABX-AEs as a strategy to reduce unnecessary antibiotic use.

Five-year serological and clinical evolution of chronic Chagas disease patients in Cochabamba, Bolivia.

BACKGROUND: Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected infectious disease that exerts the highest public health burden in the Americas. There are two anti-parasitic drugs approved for its treatment-benznidazole and nifurtimox-but the absence of biomarkers to early assess treatment efficacy hinders patients´ follow-up. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a longitudinal, observational study among a cohort of 106 chronically T. cruzi-infected patients in Cochabamba (Bolivia) who completed the recommended treatment of benznidazole. Participants were followed-up for five years, in which we collected clinical and serological data, including yearly electrocardiograms and optical density readouts from two ELISAs (total and recombinant antigens). Descriptive and statistical analyses were performed to understand trends in data, as well as the relationship between clinical symptoms and serological evolution after treatment. Our results showed that both ELISAs documented average declines up to year three and slight inclines for the following two years. The recorded clinical parameters indicated that most patients did not have any significant changes to their cardiac or digestive symptoms after treatment, at least in the timeframe under investigation, while a small percentage demonstrated either a regression or progression in symptoms. Only one participant met the "cure criterion" of a negative serological readout for both ELISAs by the final year. CONCLUSIONS/SIGNIFICANCE: The study confirms that follow-up of benznidazole-treated T. cruzi-infected patients should be longer than five years to determine, with current tools, if they are cured. In terms of serological evolution, the single use of a total antigen ELISA might be a more reliable measure and suffice to address infection status, at least in the region of Bolivia where the study was done. Additional work is needed to develop a test-of-cure for an early assessment of drugs´ efficacy with the aim of improving case management protocols.

Autoeficacia académica en estudiantes de carreras de la salud de una universidad tradicional chilena / Academic self-efficacy among health care undergraduate students in a Chilean university

Background: Self-efficacy refers to people's expectations about personal resources available for goal achievement. Higher self-efficacy expectations are correlated with higher academic performance. Aim: To analyze the psychometric properties of the Academic Behavior Self-Efficacy Scale (ABSES) and to describe Self-efficacy expectations of students from health-related careers. Material and Methods: A non-probabilistic sample of 479 first- and second-year students from Nursing, Physiotherapy, Medicine, Nutrition and Medical Technology in a public university in Chile, answered the ABSES. Results were analyzed by Exploratory Factor Analysis and its reliability was evaluated using Cronbach's alpha. Also a descriptive analysis and a non-parametric relational analysis were performed. Results: Two factors were identified: Attention and Participation. Attention obtained significantly higher scores than Participation (p < 0.001). Compared to their second-year counterparts, first year students had higher scores in Attention (p < 0.001) and Participation (p < 0.01). Medicine students had higher scores in Participation than students from other careers. Conclusions: A two factor solution was identified for ABSES. Surveyed students had a predominantly passive Self-efficacy, focused in attention. Also, a reduction in self efficacy was noted among second year students.

Prácticas corporales acerca del cuidado de sí en la comunidad indígena Sikuani / Body practice about the self-care in the Sikuani indigenous community

Antecedentes. Las categorías de cuerpo y movimiento se configuran como ejes fundamentales, tanto del quehacer como de la construcción de saberes por parte de los (las) Fisioterapeutas. Este conocimiento, históricamente influido por el contexto sociocultural, erige la condición de sujeto social en tanto que entiende la necesidad de reconocer el patrimonio cultural del país y sus particularidades en la práctica e investigación en salud. Objetivo. Develar, ¿cómo son las prácticas corporales acerca del cuidado de sí, en la comunidad indígena sikuani? Materiales y métodos. Los diarios de campo y la cartografía social fueron usados como descriptores de tales prácticas, siete de las cuales son analizadas en pos de relacionar el sentido y significado de las mismas. Resultados. Se encontraron siete prácticas del cuidado de sí que encarnan el arte de vivir por el que apuesta la comunidad. El cuidarse, el cuidado y el conocimiento de sí, forman parte de la ética del cuidado y que tiene como protagonista de estas prácticas a las mujeres. Conclusión. Un papel importante dentro de la experiencia vuelve a ser el de la mujer, ya que son ellas las encargadas de garantizar el cuidado de los niños y del esposo; sobre su cuerpo recae la responsabilidad de mantener y proveer al núcleo familiar, tan importante para la organización social de la comunidad. Es ella la encargada de influir y direccionar las relaciones dentro de su familia y de garantizar la continuidad de sus tradiciones ancestrales.

Background. The categories of human body and movement are configured as basic axes, not only as tasks, but also in the construction of knowledge by physiotherapists. Historically, this knowledge has been influenced by the sociocultural context, which creates the social subject status, because it understands the need of recognize the cultural patrimony of the country and its particularities in the practice and in the health research. Objective. To deveal, how are the body practices about the self care in the sikuani indigenous community? Materials and methods. The fields diaries and the social cartography were used as descriptors of body practices; from those, seven were analysed to relationate their sense and their meaning. Results. Seven practices of self care that describes the art of living of the community were found. The self care, the care and the self knowledge constitute the care ethics and the main characters of these practices are the females. Conclusion. In this experience, the women's role is very important, because they are in charge to guarantee the care of the children and their housebound. Over their own bodies lies the responsibility to maintain and to provide the familiar nucleon, which is very important for the community social organization. The women are in charge to guide the relationships inside their families and to guarantee the continuity of their ancestral traditions.