Browsing by Author "Salven, James"

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    Comparison of Macrolide Use in Hospitalized Children with Community Acquired Pneumonia (CAP) Before and After the Publication of Clinical Practice Guidelines
    (Office of the Vice Chancellor for Research, 2014-04-11) Kafle, Maheshwor; Wilkie, Laurie; Coffelt, Tom; Salven, James
    Introduction The 2011 Pediatric Infectious Disease Society (PIDS) and Infectious Diseases Society of America (IDSA) guidelines for treatment of community-acquired pneumonia (CAP) in children recommend the addition of a macrolide to a beta-lactam antibiotic for hospitalized children in whom atypical pneumonia is a concern. Studies have demonstrated shorter lengths of stay for school-aged children treated with combination therapy versus those treated with a beta-lactam alone. In light of the emerging benefits of combination therapy, we sought to determine if use of macrolides for children hospitalized with CAP had changed after the publication of the PIDS/IDSA guidelines. Methods Administrative records for children with a primary discharge diagnosis of pneumonia from January 1, 2009 through June 30, 2013, were collected from the Pediatric Health Information System (PHIS) database. The number of children who received macrolides prior to (pre-guideline group) and after (post-guideline group) publication of the guidelines were compared using Chi Square test. Groups were further analyzed based on age to determine if macrolides had been used more frequently in school-aged children. Results There was not a significant overall difference in the use of macrolides before and after publication of the IDSA guidelines (p0.18). Of the pre-guideline group (n=6496), 31.1% received a macrolide, compared to 32.4% of the post-guideline group (n=3527). There was also not a significant change in the use of macrolides by age: infant/preschool (0-5yrs), p0.12; young school-aged (6-10yrs), p0.33; older school-aged (≥11yrs) p0.98. Discussion The lack of a significant increase in the use of macrolides after publication of the guidelines may be due to many factors, including a time lag between publication and adoption into clinical practice. Further studies using data collected after publication of the guidelines will provide insight into clinical practice changes. Of particular interest will be whether use of macrolides in school-aged children will increase given the demonstrated benefits in length of hospitalization for this age group. Infant and pre-school-aged children treated with combination therapy have not been shown to benefit from the addition of a macrolide, and costs of hospitalization in this group have also been higher. Thus, further studies examining the use of macrolides for CAP in this age group would also be valuable.
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    An educational video improves physician knowledge of a public health care law that affects patient care during hospital clinical practice
    (Sage, 2021-05-31) Comer, Amber R.; Salven, James; Torke, Alexia; Medicine, School of Medicine
    When public health laws are passed that affect clinical practice within hospitals, it is important to educate physicians about best practices in implementing these laws into routine patient care in hospitals. An educational video was developed to inform physicians about a new state public health care law. This study sought to determine whether an educational video about a new state public health care law improves physicians' knowledge of the law and how to implement the law during clinical practice. A total of n=33 internal medicine physicians participated in this study. This study found that an educational video was successful in increasing physician knowledge about a new public health care law that affects clinical practice. The utilization of validated educational videos may provide a useful resource when attempting to provide education about new public health laws that effect the provision of medical care.
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    HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
    (Wolters Kluwer, 2021-06-10) McCabe, Marshall; Rush, Natalia; Lammert, Craig; Patidar, Kavish R.; Nephew, Lauren; Saxena, Romil; Ekser, Burcin; Salven, James; Kubal, Chandrashekhar; Ghabril, Marwan; Medicine, School of Medicine
    The predictors of recurrent autoimmune hepatitis (R-AIH) after liver transplantation (LT) are heterogeneous with limited data to guide immunosuppression, with little data on impact of race. Aims: To describe the incidence, predictors, and outcomes of R-AIH. Methods: We studied patients undergoing LT for AIH during 2000-2017 at our center. Liver biopsies were performed for clinical indications. R-AIH was defined using clinical and histologic criteria. Results: Among 75 patients undergoing LT for AIH (mean age 45 ± 16, 65% female individuals, 19% Black), 71 (95%) received antithymocyte globulin induction with tacrolimus-based immunosuppression. R-AIH developed in 20 (27%) patients at a median interval of 313 d (interquartile range, 155-1205). R-AIH was associated with level 2 HLA-DR mismatch (hazard ratio, 3.6; (95% confidence interval, 1.3-9.9; P = 0.01) and Black race (hazard ratio, 4.5; 95% confidence interval, 1.8-11.8; P = 0.002)] in the multivariable analysis. R-AIH developed in 62% of patients with level 2 HLA-DR mismatch on single-agent immunosuppression but in <20% of patients with no or 1 HLA-DR mismatch regardless of maintenance immunosuppression. R-AIH developed in 8 (57%) of 14 Black patients (71% on single-agent and 43% on dual-agent maintenance immunosuppression). Patient and graft survival were not impacted by R-AIH over a median follow-up of 8.3 y (interquartile range, 3-12). Conclusions: High-level HLA-DR mismatch and Black recipient race are associated with an increased risk of R-AIH. Immunosuppression did not predict R-AIH, but higher rates of disease recurrence with single-agent maintenance immunosuppression with these risk factors were observed and may guide maintenance immunosuppression in LT for AIH.