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PubMedDate not supplied

A clinical decision process model for evaluating vancomycin use with modified HICPAC guidelines. Hospital Infection Control Practice Advisory Committee.

OBJECTIVE: The objective of this study was to evaluate a clinical decision process model for the appropriateness of vancomycin use, using modified Hospital Infection Control Practice Advisory Committee (HICPAC) guidelines. DESIGN: All nondialysis vancomycin use was reviewed using the retrospective chart review method. The HICPAC guidelines were modified to distinguish between documented and suspected infections and appropriateness of vancomycin use initially and after 3 days of therapy. Data were collected on both vancomycin-use orders and vancomycin-use days. SETTING: 446-bed health maintenance organization teaching hospital. RESULTS: 758 uses of vancomycin from 1993 through 1995 were evaluated using the modified HICPAC guidelines. Initial use was appropriate in 71% of the cases, with 26% used for documented infections and 74% for suspected infections. Of the 536 orders of initial appropriate use, 176 courses of treatment with vancomycin were discontinued appropriately within 3 days. Ongoing use evaluation after 3 days revealed appropriate use in 45%, inappropriate ongoing use in 25%, and empirical ongoing use in 30% of the cases. There were adequate clinical or laboratory data available in 70% of cases after 3 days to discontinue vancomycin or to reclassify from suspected to documented infections or indications. Vancomycin-use evaluation solely after 3 days would not have disclosed 537 initial inappropriate vancomycin-use days, which were 44% of the total inappropriate use days. CONCLUSIONS: Comprehensive evaluation of vancomycin use with HICPAC guidelines should include a modification to encompass initial and 3-day reevaluation, because most initial use is for suspected, and not documented, infections. HICPAC guidelines do not address the issues of differentiating suspected from documented infection indications or ongoing empirical use. The clinical decision process model is a framework for documentation and data collection for use evaluation and addresses issues not covered in HICPAC vancomycin guidelines. This model could be used by other medical centers for evaluation of vancomycin or other antibiotics.

Anti-Bacterial Agents↗
PubMed1996

Review of recommendations of the Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, on varicella vaccine.

After US licensure of the Merck varicella vaccine for immunocompetent persons on 17 March 1995, the Advisory Committee on Immunization Practices finalized draft recommendations for varicella prevention in the public health sector. These recommendations call for routine vaccination of children at age 12-18 months with a single dose of the vaccine. Varicella vaccine preferably should be given to children at the same time they receive measles-mumps-rubella vaccine and may be given at the same time as other vaccines recommended at this age. Children ages 18 months to 12 years who have not been vaccinated as part of the routine schedule and who lack a reliable history of varicella should be vaccinated. Vaccination is desirable for persons > or = 13 years old without a reliable history of varicella. Special efforts should be made to assess the immunity of and to vaccinate susceptible persons who have close contact with persons at high risk for complications, including family contacts of immunocompromised individuals and health care workers.

Adolescent↗
PubMed1995

Recommended childhood immunization schedule United States--1995. American Academy of Pediatrics and the Advisory Committee on Immunization Practices.

The need for a single childhood immunization schedule prompted the unification of previous vaccine recommendations made by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP). In addition to presenting the newly recommended schedule for the administration of childhood vaccines, this article addresses the previous differences between the AAP and ACIP schedules, and provides the rationale for changing previous recommendations.

Age Factors↗
PubMed1996

Mortality in Canadian children with growth hormone (GH) deficiency receiving GH therapy 1967-1992. The Canadian Growth Hormone Advisory Committee.

The objective of this study was to determine the risk of death and potential for prevention of mortality in a large population of children with growth hormone deficiency (GHD). The Canadian GH Advisory Committee registry was initiated in 1967 to include all persons in Canada treated with pituitary-derived GH (1967-1985). Since 1985, the registry has been maintained for continuous surveillance of those treated with biosynthetic GH. Thirty-seven children have died out of a total of 1366 children treated for GHD in the 25 years up to December 31, 1992. Individual cases were reviewed for circumstances before death and autopsy information. The likelihood of individual deaths being caused by potentially preventable endocrine causes was graded on a scale of 1-5. Survival curves were analyzed for the children with idiopathic GHD and craniopharyngioma. Age- and sex-specific mortality rates for children with idiopathic GHD were compared with those of the general population. The overall crude mortality rate was 2.7%. The most frequent cause of mortality was tumor recurrence (11/37). A surprisingly high proportion of deaths (9/37) were caused by the preventable endocrine complications of adrenal crisis and hypoglycemia. Children with idiopathic GHD receiving GH therapy had similar age- and sex-specific mortality rates compared with general population rates, except in a high-risk subgroup of males diagnosed with GHD before 2 yr of age. The highest mortality occurred in children with GHD secondary to craniopharyngioma. We concluded that preventable sudden deaths caused by adrenal crisis continue to occur in children with hypopituitarism. A high level of vigilance must be maintained in this population.

Adolescent↗
PubMed2000

Summary of the joint statement on thimerosal in vaccines. American Academy of Family Physicians, American Academy of Pediatrics, Advisory Committee on Immunization Practices, Public Health Service.

In June 2000, a joint statement on thimerosal in vaccines was prepared by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP), and the Public Health Service (PHS) in response to 1) the progress in achieving the national goal declared in July 1999 to remove thimerosal from vaccines in the recommended childhood vaccination schedule, and 2) results of recent studies that examined potential associations between exposure to mercury in thimerosal-containing vaccines and health effects. In this statement, AAFP, AAP, ACIP, and PHS recommend continuation of the current policy of moving rapidly to vaccines that are free of thimerosal as a preservative. Until adequate supplies are available, use of vaccines that contain thimerosal as a preservative is acceptable.

Preservatives, Pharmaceutical↗
PubMed1999

Vancomycin Use in a Brazilian University Hospital: Comparison With Hospital Infection Control Practices Advisory Committee Guidelines.

Emergence of vancomycin-resistant bacteria is of concern. In an effort to reduce this danger, guidelines to ensure proper prescribing of vancomycin have been proposed by the Hospital Infections Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control. To evaluate use of vancomycin at Uberlândia University Hospital in Brazil, each patient who received the drug during a 10 month period had nasal and rectal cultures done within 48 hours of initiation of therapy, then at weekly intervals until discharge. Their hospital records were reviewed to obtain demographic and clinical data, and each was scored as to whether or not HICPAC guidelines were followed. Thirty-one patients were enrolled in the study; 15 of whom had been approved for vancomycin by the hospital infectious diseases (ID) specialist, and 16 who had the drug given without approval. During the study, 4 strains of VRE (Vancomycin Resistant Knterococci) and 8 strains of MRSA(Methicillin Resistant S.aureus) emerged. The use of vancomycin did not follow HICPAC guidelines in 21/31 patients (68%), in that the drug was prescribed empirically without prior documentation of need. This occurred 13 of 16 (81%) times when no approval by an ID specialist was provided, and 8 of 15 times (53%)after approval by a ID specialist. In 6 of 8 patients (75%), empirical use of vancomycin was approved by an ID specialist in patients with severe illnesses, each of whom subsequently died. This could be considered appropriate use, although outside the guidelines. Only 3 of 13 patients (23%) were severely ill when vancomycin was used without ID approval. Most of the vancomycin use which did not follow HICPAC guidelines occurred on the medicine service in patients moderately ill with pneumonia or bacteremia, and associated with invasive procedures. We conclude that there is a special need to improve education regarding the appropriate use of vancomycin and to increase review of its use by an ID specialist, particularly on medicine services of our hospital.

Journal Article↗
PubMed2000

Meningococcal disease and college students. Recommendations of the Advisory Committee on Immunization Practices (ACIP).

This report provides information regarding the modestly increased risk for meningococcal disease among college freshmen, particularly those who live in dormitories or residence halls. It presents recommendations developed by the Advisory Committee on Immunization Practices regarding the education of students and parents about meningococcal disease and the polysaccharide meningococcal vaccine so that they can make informed decisions regarding vaccination.

Adolescent↗
PubMed1991

Human albumin solutions: an audit of use in three major metropolitan hospitals. Subcommittee of the Victorian Drug Usage Advisory Committee.

OBJECTIVE: To evaluate the volume used and the indications for use of the human albumin solutions, stable plasma protein solution and normal serum albumin, in Victorian metropolitan teaching hospitals. DESIGN: The Victorian Drug Usage Advisory Committee conducted a prospective audit by means of a questionnaire in three major Melbourne teaching hospitals over a three-month period. All bottles of the human albumin solutions issued were numbered and a questionnaire regarding indications for use was completed for each patient treated with either product. OUTCOME MEASURES: The results were compared with the recommendations of the Australasian Society of Blood Transfusion to determine whether usage was appropriate, and the number of bottles used was analysed for each hospital and each major indication. RESULTS: The survey was comprehensive (84% of the forms were returned) and demonstrated that these products are used for appropriate clinical categories, for example, hypovolaemia, hypoalbuminaemia, and not for inappropriate indications, such as nutritional support or wound healing. There was however a marked variation in the level of usage for a given indication between the three hospitals. CONCLUSIONS: This variation reflected a considerable difference in unit policy regarding the use of these products in preference to crystalloid or synthetic colloid solutions. The variation suggests the need for more specific guidelines for the use of these products in defined clinical settings.

Albumins↗
PubMed1999

Strategies to sustain success in childhood immunizations. The National Vaccine Advisory Committee.

OBJECTIVE: Following an outbreak of measles in 1989-1991, a blueprint for change was developed to improve immunization coverage by addressing deficiencies in the immunization delivery system. A review was undertaken by the National Vaccine Advisory Committee (NVAC) to assess progress in improving immunization coverage, decreasing disease incidence, and developing an immunization delivery system to serve children in the United States. Based on this review, strategies were recommended to sustain success in immunization coverage. PARTICIPANTS: A Subcommittee on Immunization Coverage was appointed by the chairman of the NVAC in 1995 and included representatives from federal agencies, professional organizations, vaccine manufacturers, state and regional health departments, and academic centers. EVIDENCE: Presentations on immunization programs, strategies, and financing were made to the subcommittee by representatives from federal, state, and local agencies; professional organizations; insurers; businesses; and public and private health care providers. Evidence from the published literature also was reviewed. CONSENSUS PROCESS: After review and discussion of evidence presented, conclusions and recommendations were crafted and endorsed by members of the subcommittee. The subcommittee's report was submitted to the NVAC for review, comment, and approval. CONCLUSIONS: Although incidence rates of traditional vaccine-preventable diseases are at all-time low levels and corresponding vaccination coverage rates are at all-time high levels, a system to ensure timely vaccination of the 11000 US infants born each day that also incorporates newly recommended vaccines is incomplete. Key barriers include lack of financing of vaccination in many insurance programs and the lack of implementation of evidence-based interventions to raise coverage levels. The NVAC makes 15 recommendations to achieve a sustainable childhood immunization delivery system organized around (1) vaccination financing to ensure full insurance coverage of recommended vaccines and to support the Vaccines for Children program; (2) provider practices to ensure the implementation of recall/reminder systems and office-based assessment of coverage levels; (3) information systems for monitoring disease, vaccination coverage, and performance on immunization delivery; and (4) support for communities and families to ensure that the public is aware of the importance of vaccination, that resources are focused to help underserved children, that immunization linkages with WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) are enhanced, and that citizen coalitions can advocate improvements in the immunization delivery system.

Child↗