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Article ; Online: Implementation of a clinical decision support tool at time of intramuscular penicillin G prescribing reduces medication errors.

Pallotta, Andrea M / Wesolowski, Jill

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2021 Volume 78, Issue 21, Page(s) 1937–1938

MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Decision Support Systems, Clinical ; Humans ; Medication Errors/prevention & control ; Penicillin G
Chemical Substances	Anti-Bacterial Agents ; Penicillin G (Q42T66VG0C)
Language	English
Publishing date	2021-06-21
Publishing country	England
Document type	Letter
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.1093/ajhp/zxab256
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Zs.A 419: Show issues

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Article ; Online: Baricitinib versus tocilizumab in critically ill COVID-19 patients: A retrospective cohort study.

Conroy, Grace M / Bauer, Seth R / Pallotta, Andrea M / Duggal, Abhijit / Wang, Lu / Sacha, Gretchen L

Pharmacotherapy

2023 Volume 44, Issue 1, Page(s) 28–38

Abstract: Objectives: The immunomodulators tocilizumab and baricitinib improve outcomes in severely ill patients with coronavirus disease 2019 (COVID-19); however, comparative analyses of clinical outcomes related to these agents are lacking. A tocilizumab ... ...

Abstract	Objectives: The immunomodulators tocilizumab and baricitinib improve outcomes in severely ill patients with coronavirus disease 2019 (COVID-19); however, comparative analyses of clinical outcomes related to these agents are lacking. A tocilizumab national shortage shifted treatment to baricitinib in critically ill patients, allowing for an outcome comparison in a similar population. The purpose of this study is to compare clinical outcomes in critically ill COVID-19 patients who received tocilizumab and those who received baricitinib. Design: Retrospective, observational cohort study using generalized estimating equation models, accounting for clustering by hospital and known confounders, to estimate the proportional odds of the ordinal World Health Organization Clinical Progression Scale (WHO-CPS) score at day 14, the primary outcome. Secondary outcomes included WHO-CPS score at day 7. Setting: Multiple hospitals within the Cleveland Clinic Health System. Patients: Adult patients admitted for COVID-19 between January 2021 and November 2021. Interventions: Receipt of tocilizumab, before its shortage, or baricitinib, during shortage. Measurements and main results: In total, 507 patients were included; 217 received tocilizumab and 290 received baricitinib. Over 96% of patients required ICU admission and 98% received concomitant dexamethasone. Tocilizumab recipients had higher (worse) baseline WHO-CPS scores. After adjustment, tocilizumab use was associated with higher odds of a worse day 14 WHO-CPS score compared with baricitinib (adjusted odds ratio [OR] 1.65 [95% confidence interval (CI) 1.10-2.48]). Similarly, after adjustment, tocilizumab use was associated with higher odds of a worse day 7 WHO-CPS score (adjusted OR 1.65 [95% CI 1.22-2.24]). Conclusions: Baricitinib use was associated with better WHO-CPS scores at day 14 and day 7 compared with tocilizumab in a cohort of critically ill patients with COVID-19. The odds of having a one unit increase in WHO-CPS score at day 14 was 71% higher with tocilizumab than baricitinib. No difference in mortality or adverse effects was noted.
MeSH term(s)	Adult ; Humans ; COVID-19 ; COVID-19 Drug Treatment ; Critical Illness ; Retrospective Studies ; Purines ; Pyrazoles ; Sulfonamides ; Antibodies, Monoclonal, Humanized ; Azetidines
Chemical Substances	baricitinib (ISP4442I3Y) ; tocilizumab (I031V2H011) ; Purines ; Pyrazoles ; Sulfonamides ; Antibodies, Monoclonal, Humanized ; Azetidines
Language	English
Publishing date	2023-08-24
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	603158-4
ISSN	1875-9114 ; 0277-0008
ISSN (online)	1875-9114
ISSN	0277-0008
DOI	10.1002/phar.2867
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Zs.A 1738: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Monoclonal antibodies for treating COVID-19.

Pallotta, Andrea M / Kim, ChungYun / Gordon, Steven M / Kim, Alice

Cleveland Clinic journal of medicine

2021

Abstract: Bamlanivimab and casirivimab-imdevimab are novel virus-neutralizing monoclonal antibodies authorized to treat mild to moderate COVID-19 in outpatients at risk for progression to severe disease. Treatment early in the disease may show efficacy in reducing ...

Abstract	Bamlanivimab and casirivimab-imdevimab are novel virus-neutralizing monoclonal antibodies authorized to treat mild to moderate COVID-19 in outpatients at risk for progression to severe disease. Treatment early in the disease may show efficacy in reducing progression to severe disease, although safety and efficacy data are limited. They are not authorized for hospitalized patients with more advanced disease.
Language	English
Publishing date	2021-02-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.88a.ccc074
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Ua VI Zs.212: Show issues

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Article ; Online: Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).

Deshpande, Abhishek / Walker, Ramara / Schulte, Rebecca / Pallotta, Andrea M / Tereshchenko, Larisa G / Hu, Bo / Kadri, Sameer S / Klompas, Michael / Rothberg, Michael B

Trials

2023 Volume 24, Issue 1, Page(s) 595

Abstract: Background: Community-acquired pneumonia (CAP) is a significant public health concern and a leading cause of hospitalization and inpatient antimicrobial use in the USA. However, determining the etiologic pathogen is challenging because traditional ... ...

Abstract	Background: Community-acquired pneumonia (CAP) is a significant public health concern and a leading cause of hospitalization and inpatient antimicrobial use in the USA. However, determining the etiologic pathogen is challenging because traditional culture methods are slow and insensitive, leading to prolonged empiric therapy with extended-spectrum antibiotics (ESA) that contributes to increased hospital length of stay, and antimicrobial resistance. Two potential ways to reduce the exposure to ESA are (a) rapid diagnostic assays that can provide accurate results within hours, obviating the need for empiric therapy, and (b) de-escalation following negative bacterial cultures in clinically stable patients. Methods: We will conduct a large pragmatic 2 × 2 factorial cluster-randomized controlled trial across 12 hospitals in the Cleveland Clinic Health System that will test these two approaches to reducing the use of ESA in adult patients (age ≥ 18 years) with CAP. We will enroll over 12,000 patients and evaluate the independent and combined effects of routine use of rapid diagnostic testing at admission and pharmacist-led de-escalation after 48 h for clinically stable patients with negative cultures vs usual care. We hypothesize that both approaches will reduce days on ESA. Our primary outcome is the duration of exposure to ESA therapy, a key driver of antimicrobial resistance. Secondary outcomes include detection of respiratory viruses, treatment with anti-viral medications, positive pneumococcal urinary antigen test, de-escalation by 72 h from admission, re-escalation to ESA after de-escalation, total duration of any antibiotic, 14-day in-hospital mortality, intensive care unit transfer after admission, healthcare-associated C. difficile infection, acute kidney injury, total inpatient cost, and hospital length-of-stay. Discussion: Our study aims to determine whether identifying an etiological agent early and pharmacist-led de-escalation (calling attention to negative cultures) can safely reduce the use of ESA in patients with CAP. If successful, our findings should lead to better antimicrobial stewardship, as well as improved patient outcomes and reduced healthcare costs. Our findings may also inform clinical guidelines on the optimal management of CAP. Trial registration: ClinicalTrials.gov NCT05568654 . Registered on October 4, 2022.
MeSH term(s)	Adult ; Humans ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents/therapeutic use ; Clostridioides difficile ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Cross Infection ; Inpatients ; Pneumonia ; Randomized Controlled Trials as Topic
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents
Language	English
Publishing date	2023-09-16
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-023-07615-3
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Article ; Online: Is posteromedial translation with sublaminar bands effective in correcting axial rotation in adolescent idiopathic scoliosis surgery? A 3D reconstruction study.

Gallazzi, Enrico / Pallotta, Ludovica Maria / La Maida, Giovanni Andrea / Luca, Andrea / Bassani, Tito / Brayda-Bruno, Marco

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

2022 Volume 32, Issue 1, Page(s) 202–209

Abstract: ... Methods: A prospective evaluation of 50 consecutive cases (41 F, 9 M, mean age 14.7 ± 2 years) of AIS ...

Abstract	Purpose: Hybrid constructs with sublaminar bands have recently regained popularity as an alternative to all-screw construct for correction of adolescent idiopathic scoliosis (AIS). The aim of this study is to evaluate the ability of hybrid constructs with sublaminar bands to achieve a tridimensional correction of the scoliotic deformity. Our hypothesis is that hybrid construct with sublaminar bands are able to achieve a substantial derotation of the apical vertebrae, while preserving the thoracic kyphosis. Methods: A prospective evaluation of 50 consecutive cases (41 F, 9 M, mean age 14.7 ± 2 years) of AIS correction with hybrid construct was performed. In all cases, sublaminar bands were used at the apex of the main curve on concave side. All patients underwent pre and postoperative X-rays with EOS System, with full 3D reconstruction. Spinopelvic parameters and axial rotation of the vertebrae were measured pre and postoperatively. Results: 2.7 ± 0.9 mean sublaminar bands were used per patient. Mean correction of deformity was 50 ± 9.5%. on the coronal plane. The mean axial rotation of the apical vertebra went from 18° ± 11.5° preoperatively to 9.4° ± 7.2° postoperatively (p < 0.001) with a mean derotation of 47.7%. Thoracic kyphosis went from 32.1° ± 18° preoperatively to 37.3° ± 13.1° postoperatively (p < 0.05). No intraoperative complications due to sublaminar bands were recorded. Conclusions: Hybrid construct with sublaminar band have been showed to be safe and effective in deformity correction and in maintaining or restoring thoracic kyphosis. This study showed that with sublaminar bands applied at the curve apex a substantial derotation of the apical vertebrae can be achieved.
MeSH term(s)	Humans ; Adolescent ; Child ; Scoliosis/diagnostic imaging ; Scoliosis/surgery ; Rotation ; Imaging, Three-Dimensional ; Thoracic Vertebrae/diagnostic imaging ; Thoracic Vertebrae/surgery ; Spinal Fusion/methods ; Retrospective Studies ; Kyphosis/diagnostic imaging ; Kyphosis/surgery ; Treatment Outcome
Language	English
Publishing date	2022-11-13
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1115375-1
ISSN	1432-0932 ; 0940-6719
ISSN (online)	1432-0932
ISSN	0940-6719
DOI	10.1007/s00586-022-07449-8
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Zs.A 3437: Show issues

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Article: Evaluation of Dolutegravir- and Bictegravir-Based Antiretroviral Regimen Utilization in Patients who Cannot Take Medications by Mouth.

LoFaso, Megan / Marchionda, Olivia / Bass, Stephanie / Torbic, Heather / Blackewicz, Caitlin / Pallotta, Andrea

Open forum infectious diseases

2023 Volume 10, Issue 12, Page(s) ofad554

Abstract: A retrospective review of patients unable to take medications by mouth showed short interruptions of therapy for most patients. In a secondary analysis, our data showed maintenance and/or achievement of viral suppression for most patients. A ... ...

Abstract	A retrospective review of patients unable to take medications by mouth showed short interruptions of therapy for most patients. In a secondary analysis, our data showed maintenance and/or achievement of viral suppression for most patients. A retrospective review of intensive care patients unable to take antiretrovirals by mouth showed 56.6% of patients experiencing a transient interruption in therapy. Additionally, our case series further supports previous literature on crushing dolutegravir and bictegravir regimens to maintain and achieve viral suppression.
Language	English
Publishing date	2023-11-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofad554
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Article ; Online: Spinal cord compression in thoracolumbar burst fractures: application of high-definition three-dimensional exoscope in minimally invasive lateral surgery.

Giorgi, Pietro Domenico / Pallotta, Maria Ludovica / Legrenzi, Simona / Nardi, Michele / Andrea, Manzoni / Schirò, Giuseppe Rosario

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

2022 Volume 33, Issue 5, Page(s) 2173–2177

Abstract: Study design: Spinal cord decompression in thoracolumbar burst fractures is challenging. Development of minimally invasive approaches and the improvement in new magnification technologies allowed a better and safer surgical treatment for these complex ... ...

Abstract	Study design: Spinal cord decompression in thoracolumbar burst fractures is challenging. Development of minimally invasive approaches and the improvement in new magnification technologies allowed a better and safer surgical treatment for these complex spinal injuries. We reported our experience in the minimally invasive surgical treatment of thoracolumbar burst fractures with spinal cord compression supported by high-definition (HD) three-dimensional (3D) Video-assisted telescope operating monitor (VITOM) or exoscope. Objectives: To assess the role and potential advantages of exoscope in the minimally invasive surgery of traumatic thoracolumbar spinal cord compression comparing traditional magnification systems. Setting: The study was conducted in a Northern Italy Spinal Trauma Center. Methods: We reported 10 consecutive thoracolumbar (T11-L2) burst fractures associated with spinal cord compression treated with minimally invasive corpectomy and exoscope-assisted spinal decompression. Three main indicators were retrospectively analyzed: surgical time, blood loss, and intraoperative complications. The data were compared with those obtained from an equal sample of 10 procedures performed by the same surgeon with the same technique, but traditional microscope assisted. User impressions in terms of ergonomics, magnification, and image quality were rated differently. Results: A small reduction of surgical time and blood loss were observed in the exoscope assisted group. There were no intraoperative complications attributed to visualization mode or conversion to the traditional microscope in any procedure. In our experience the exoscope allowed a better magnification and image definition with better ergonomics and user-friendliness. Conclusions: In our preliminary experience the exoscope new technology is a safe and effective tool for spinal cord minimally invasive decompression in thoracolumbar burst fractures. The stereoscopic vision provided by 3D images seems to be crucial in hand eye coordination. There are clear advantages in terms of maneuverability, wide field of view, deep focus, and more comfortable posture for the spinal surgeon.
MeSH term(s)	Humans ; Spinal Cord Compression/etiology ; Spinal Cord Compression/surgery ; Retrospective Studies ; Laminectomy ; Decompression, Surgical/methods ; Minimally Invasive Surgical Procedures ; Spinal Fractures/surgery
Language	English
Publishing date	2022-07-26
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	1231084-0
ISSN	1432-1068 ; 1633-8065 ; 0948-4817 ; 0940-3264
ISSN (online)	1432-1068
ISSN	1633-8065 ; 0948-4817 ; 0940-3264
DOI	10.1007/s00590-022-03319-7
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Zs.A 3479: Show issues

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Article ; Online: Impact of a standardized order set and medication-use process on medication error rates in sexual assault patients presenting to the emergency department for HIV nonoccupational postexposure prophylaxis.

Segovia, Margaret F / Pallotta, Andrea M / Campbell, Matthew J / Englund, Kristin / Reali-Sorrell, Michele / Shah, Sneha S

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2022 Volume 80, Issue 6, Page(s) 365–372

Abstract: Purpose: To evaluate the impact of a standardized order set and medication-use process on antiretroviral medication errors in sexual assault (SA) patients presenting to the emergency department (ED) for nonoccupational postexposure prophylaxis (nPEP).!## ...

Abstract	Purpose: To evaluate the impact of a standardized order set and medication-use process on antiretroviral medication errors in sexual assault (SA) patients presenting to the emergency department (ED) for nonoccupational postexposure prophylaxis (nPEP). Methods: In November 2019, a multidisciplinary group collaborated on an initiative to improve the nPEP medication-use process for SA patients presenting to the EDs within a large integrated health system. Electronic medical records of patients 13 years of age or older who presented for SA examination and were prescribed nPEP during the pre- (February 2018-August 2019) and poststandardization (February 2020-August 2021) periods were included. The primary objective was to compare the proportion of patients experiencing a medication error before and after SA/nPEP process standardization. Data regarding the following medication errors were evaluated: incomplete regimen; inappropriate/duplicative regimen; dosing, frequency, or quantity prescribed error; and initiation of nPEP without an HIV test. Results: Two hundred six patients met criteria for inclusion. A higher proportion of patients experienced medication errors in the prestandardization group relative to the poststandardization group (46.5% vs 11.9%, P < 0.001). Fifty-five errors were observed in the prestandardization group, compared to 16 errors in the poststandardization group. The majority of errors in the prestandardization group were directly related to antiretroviral regimens, while the majority of errors in the poststandardization group involved initiation of nPEP without an HIV test. Conclusion: The standardization of the SA/nPEP process was associated with significantly lower medication error rates. Optimization of medication-use technology is an effective strategy in reducing medication errors.
MeSH term(s)	Humans ; Medication Errors/prevention & control ; Emergency Service, Hospital ; Electronic Health Records ; Anti-Retroviral Agents ; Post-Exposure Prophylaxis ; HIV Infections/drug therapy ; HIV Infections/prevention & control
Chemical Substances	Anti-Retroviral Agents
Language	English
Publishing date	2022-12-11
Publishing country	England
Document type	Journal Article
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.1093/ajhp/zxac371
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Article ; Online: Intravenous to Oral Antibiotic Switch Therapy Among Patients Hospitalized With Community-Acquired Pneumonia.

Deshpande, Abhishek / Klompas, Michael / Guo, Ning / Imrey, Peter B / Pallotta, Andrea M / Higgins, Thomas / Haessler, Sarah / Zilberberg, Marya D / Lindenauer, Peter K / Rothberg, Michael B

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2023 Volume 77, Issue 2, Page(s) 174–185

Abstract: Background: Community-acquired pneumonia (CAP) is a leading cause of hospital admissions and antimicrobial use. Clinical practice guidelines recommend switching from intravenous (IV) to oral antibiotics once patients are clinically stable.: Methods: ... ...

Abstract	Background: Community-acquired pneumonia (CAP) is a leading cause of hospital admissions and antimicrobial use. Clinical practice guidelines recommend switching from intravenous (IV) to oral antibiotics once patients are clinically stable. Methods: We conducted a retrospective cohort study of adults admitted with CAP and initially treated with IV antibiotics at 642 US hospitals from 2010 through 2015. Switching was defined as discontinuation of IV and initiation of oral antibiotics without interrupting therapy. Patients switched by hospital day 3 were considered early switchers. We compared length of stay (LOS), in-hospital 14-day mortality, late deterioration (intensive care unit [ICU] transfer), and hospital costs between early switchers and others, controlling for hospital characteristics, patient demographics, comorbidities, initial treatments, and predicted mortality. Results: Of 378 041 CAP patients, 21 784 (6%) were switched early, most frequently to fluoroquinolones. Patients switched early had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter LOS, and lower hospitalization costs, but no significant excesses in 14-day in-hospital mortality or late ICU admission. Patients at a higher mortality risk were less likely to be switched. However, even in hospitals with relatively high switch rates, <15% of very low-risk patients were switched early. Conclusions: Although early switching was not associated with worse outcomes and was associated with shorter LOS and fewer days on antibiotics, it occurred infrequently. Even in hospitals with high switch rates, <15% of very low-risk patients were switched early. Our findings suggest that many more patients could be switched early without compromising outcomes.
MeSH term(s)	Adult ; Humans ; Retrospective Studies ; Pneumonia/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Hospitalization ; Length of Stay ; Community-Acquired Infections/drug therapy ; Administration, Oral
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-07-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad196
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Article ; Online: Spinal cord stimulator medullary compression-a very rare SCS complication and surgical treatment.

Pallotta, Maria Ludovica / Lovi, Alessio / Luca, Andrea / Babbi, Lisa / Brayda-Bruno, Marco

Spinal cord series and cases

2022 Volume 8, Issue 1, Page(s) 84

Abstract: Introduction: The risk of spinal cord damage after Spinal Cord Stimulator (SCS) implant is a very rare event. In our case report, the patient was affected by a progressively worsening spinal stenosis due to SCS compression.: Case report: The authors ... ...

Abstract	Introduction: The risk of spinal cord damage after Spinal Cord Stimulator (SCS) implant is a very rare event. In our case report, the patient was affected by a progressively worsening spinal stenosis due to SCS compression. Case report: The authors describe a progressive paraparesis in a 58-year-old woman with a long history of back pain and multiple spine surgeries. Computed tomography (CT) outlined vertebral canal stenosis corresponding to an electrode array implanted in T9. A posterior T8-T10 spinal cord decompression with explanation of the SCS device was performed and a partial neurological improvement was observed immediately postoperative. Discussion: Spinal cord stimulation has been used since 1967 for the treatment of refractory chronic pain, particularly failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). Still, the mechanism underlying its function is not completely clear. Moreover, complications are mainly related to implant dysfunction and the risk of direct and indirect spinal cord compression is described as exceptional in the literature. Our aim is to describe the case SCS device spinal cord direct compression and its surgical treatment.
MeSH term(s)	Complex Regional Pain Syndromes/complications ; Complex Regional Pain Syndromes/therapy ; Failed Back Surgery Syndrome/complications ; Failed Back Surgery Syndrome/therapy ; Female ; Humans ; Middle Aged ; Spinal Cord Compression/etiology ; Spinal Cord Compression/surgery ; Spinal Cord Stimulation/adverse effects ; Spinal Cord Stimulation/methods ; Spinal Stenosis/complications ; Spinal Stenosis/surgery
Language	English
Publishing date	2022-10-14
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	2058-6124
ISSN (online)	2058-6124
DOI	10.1038/s41394-022-00550-6
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