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Objective The goal of this study is to evaluate treatment times regarding acute ischemic stroke and identify barriers to implementing stroke care at the Ouachita County Medical Center Emergency Department. Methods A retrospective review of medical records was conducted of patients who presented with acute ischemic stroke to the Ouachita County Medical Center Emergency Department between 2020 and 2023 and received intravenous (IV) r-tPA. The primary focus of this study was to analyze door-to-needle time with IV r-tPA. To determine areas of improvement, this study examined door-to-initial physician evaluation, door-to-CT, door-to-tele neurologist evaluation, and door-to-IV r-tPA administration. Results A total of 26 patients who received treatment with IV r-tPA for acute ischemic stroke were included in this study. Twenty-three patients (88%; n=26) received IV- r-tPA within the recommended 60-minute window with a mean treatment time of 44.5 minutes. The mean door-to-physician evaluation time for patients presenting with acute ischemic stroke was 1.81 minutes. All patients received CT scans within 28 minutes of arrival with the mean time being 5.08 minutes. Teleneurologist evaluation was initiated within 59 minutes of presentation with a mean time of 25.19 minutes. Conclusion Evaluation of treatment times at the Ouachita County Medical Center Emergency Department confirms that stroke care received at this facility adheres to the recommendations outlined by the American Stroke Association. Nevertheless, clinicians should always strive for improvement. Through extensive evaluation of the treatment process, we were able to provide recommendations to further decrease treatment times and improve overall clinical outcomes.
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BACKGROUND: Despite research and efforts to mitigate bacterial resistance, antibiotic overprescribing continues to occur, often due to real or perceived expectations of patients. Objective: The purpose of this study was to determine: (1) if there's an association between the provider's patient education efforts and the patient's satisfaction, and (2) the research participant's subsequent behavior concerning antibiotic prescriptions, by utilizing the Stewardship Through Educating Patients (S.T.E.P.) process for positive prescriptive change. The S.T.E.P. program features straightforward, simple education via face-to-face counseling at patient encounters, along with presenting applicable printed educational pamphlets from the Centers for Disease Control and Prevention (CDC). These two interventions were utilized in this study with research participants from the healthcare provider, with education focused on appropriate antibiotic use in the treatment of adults diagnosed with common illnesses such as an upper respiratory infection (the common cold), acute sinusitis, and acute bronchitis, which oftentimes are viral in origin. METHOD: This Quality Improvement (QI) interventional study utilized the researcher's direct face-to-face patient education and CDC printed materials as a measure of antibiotic prescribing as a primary outcome, with patient satisfaction as a secondary outcome via convenience sampling of 40 hospital employees who utilized a free hospital-based employee healthcare clinic. RESULTS: Patient-teaching by this study's researcher, along with supplemental printed patient education material from the CDC that were given to research participants during an initial medical encounter, were effective interventions used in reducing antibiotic prescribing, as evidenced by a positive patient satisfaction in 95% of research participants. CONCLUSIONS: Antibiotic use in the treatment of adults diagnosed with common illnesses such as an upper respiratory infection (the common cold), acute sinusitis, and acute bronchitis, may be safely reduced by using a combination of patient-education and clinician intervention.
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Background The changing epidemiology of pneumonia is due to aging hosts and the emergence of new pathogens that require ongoing evaluation and updates on antibiotic treatment. Guidelines from the 2019 Infectious Diseases of American Society/American Thoracic Society (IDSA/ATS) provide recommendations for the treatment and management of community-acquired pneumonia (CAP) with risk for methicillin-resistant Staphylococcus aureus (MRSA) and/or Pseudomonas aeruginosa. The objective of this research is to examine patients with CAP with risk for MSRA and/or Pseudomonas aeruginosa to assess the overuse of extended-spectrum antibiotics. Methods A retrospective study using a convenience sample of medical records from 118 adult patients with CAP with risk factors for MRSA and/or Pseudomonas was completed from August to December 2019. Descriptive analyses were employed to compute the number and percentages of demographic variables (age, gender), overuse of antibiotics, duration of treatment, and risk factors. Results Of 118 patients, 59.3% were males and 77.9% were aged 60 years and older. Seventy-four percent (74%) of patients were prescribed extended-spectrum antibiotics. Most patients (42%) were treated with extended-spectrum antibiotics and did not meet the risk factors based on the 2019 IDSA/ATS recommended guidelines. Twenty percent (20%) were prescribed antibiotics for eight days or more. Patients with known risk factors, including low positive blood (5%) and respiratory (26%) cultures, antibiotic use (25%), and admission to the hospital within 90 days (30%) were identified. Conclusion In this sample, the overuse of antibiotics was high. The significant percentage of patients that were over-treated with extended-spectrum antibiotics could lead to adverse outcomes.
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Since its inception in 1975, the hybridoma technology revolutionized science and medicine, facilitating discoveries in almost any field from the laboratory to the clinic. Many technological advancements have been developed since then, to create these "magical bullets." Phage and yeast display libraries expressing the variable heavy and light domains of antibodies, single B-cell cloning from immunized animals of different species including humans or in silico approaches, all have rendered a myriad of newly developed antibodies or improved design of existing ones. However, still the majority of these antibodies or their recombinant versions are from hybridoma origin, a preferred methodology that trespass species barriers, due to the preservation of the natural functions of immune cells in producing the humoral response: antigen specific immunoglobulins. Remarkably, this methodology can be reproduced in small laboratories without the need of sophisticate equipment. In this chapter, we will describe the most recent methods utilized by our Monoclonal Antibodies Core Facility at the University of Texas-M.D. Anderson Cancer Center. During the last 10 years, the methods, techniques, and expertise implemented in our core had generated more than 350 antibodies for various applications.