Announcements

Research and Pharmacy Teams Collaborate on Historic “Win” for ABSMC

Posted on Feb 1, 2021 in Announcements | 0 comments

https://newsplus.sutterhealth.org/blog/2021/01/27/research-and-pharmacy-teams-collaborate-on-historic-win-for-absmc/?doing_wp_cron=1611861806.2731199264526367187500

EBAC Helps Prolong and Improve the Lives of Those Afflicted with HIV

Posted on Feb 1, 2021 in Announcements | 0 comments

While the world begins immunizing the public against COVID-19, our EBAC team led by Christopher Hall, M.D., is leading a research initiative in the East Bay that may provide even more HIV prevention options. Thank you to our EBAC staff members for their amazing work.

https://vitals.sutterhealth.org/no-vaccine-for-this-virus-but-advances-have-saved-lives/

CDC Update to Gonococcal Infection Treatment

Posted on Feb 1, 2021 in Announcements | 0 comments

CDC Update to Gonococcal Infection Treatment

Neisseria gonorrhoeae is an important cause of sexually transmitted diseases and can lead to complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility. While effective treatment can prevent complications and transmission, N. gonorrhoeae can rapidly develop resistance to antibiotics.

In December 2020, the CDC has updated its guidelines on gonococcal treatment. The CDC now recommends a single 500 mg intramuscular (IM) dose of ceftriaxone for treatment of uncomplicated gonococcal infection of the urogenital, anorectal, and/or pharyngeal region. For patients weighing 150 kg or more, 1 gram of ceftriaxone IM is recommended. In cases where chlamydial infection remains in the differential, doxycycline 100 mg orally twice daily for 7 days is recommended. Prior guidelines from 2010 recommended a single 250 mg IM dose of ceftriaxone and a single 1 gram dose of oral azithromycin.

This change in recommendation comes from increasing N. gonorrhoeae resistance to azithromycin. In the United States, N. gonorrhoeae resistance to azithromycin increased from 0.6% in 2013 to 4.6% in 2018. This, along with additional evidence concerning for reduced efficacy of azithromycin to treat chlamydial infections, especially rectal infections, has led to the decrease in strength of recommendation for azithromycin. In pregnant patients, oral azithromycin 1 gram as a single dose is still recommended to treat chlamydia. Meanwhile, N. gonorrhoeae remains susceptible to ceftriaxone. However, pharmacokinetic and pharmacodynamic studies demonstrate the need for higher ceftriaxone doses to avoid treatment failure, especially for pharyngeal gonorrhea treatment. Monitoring for emergence of ceftriaxone resistance will be essential for ensuring continued efficacy of the recommended regimens.

References:

St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. DOI: http://dx.doi.org/10.15585/mmwr.mm6950a6external icon

Why Sutter Community Connect

Posted on Jan 4, 2021 in Announcements | 0 comments

Urine Culture Stewardship – Avoiding Screening and Treatment of Asymptomatic Bacteriuria

Posted on Dec 2, 2020 in Announcements | 0 comments

Urine Culture Stewardship – Avoiding Screening and Treatment of Asymptomatic Bacteriuria 

Urine culture stewardship aims to ensure that urine cultures are only performed when appropriate indications are present to prevent unnecessary collection and treatment of asymptomatic bacteriuria.

The IDSA (Infectious Diseases Society of America) recommends against screening and treating asymptomatic bacteriuria in most cases, with the exception of pregnant women and those undergoing urological procedures associated with mucosal trauma. In elderly patients with cognitive impairment presenting with confusion without systemic signs of infection, assessment for other causes and careful observation rather than antimicrobial therapy is strongly recommended. There is a lack of evidence that treatment is beneficial in this population, with greater risk of adverse outcomes from antimicrobial therapy, including increased resistance, C. difficile infection, and adverse drug effects.

By implementing Urine Culture Stewardship, hospitals can decrease the total number of urine cultures ordered, the number of inappropriate asymptomatic bacteriuria treatments, and costs related to overtreatment without increasing patient adverse events.

References:

Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP).

Nicolle LE et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis, 2019: 68(10):e83-110. 

Cultivating a Sense of Gratitude – Learning to better appreciates of gifts of a healthcare provider

Posted on Dec 2, 2020 in Announcements, Wellness Committee | 0 comments

2020 has been an incredibly tough year: COVID-19 rages across the country completely altering the way we work and live and putting our lives in danger, then there has been all the political and social unrest.  Yet as we approach the time of year when we traditionally seek a sense of gratitude, there is still much to be thankful for.  Those of us with ABSMC have been able to get paid, get out of the house and, I hope, have health in our families.

While our work is meaningful, finding the moment to moment, patient to patient sense of gratitude is not always so easy.  When I talk about healthcare and gratitude, I often hear, “Yeah, I wish my patients were more grateful for all I do.”  While I understand this sentiment, it misses something fundamental in the provider patient relationship. To develop a deep sense of gratitude as a provider, it helps to understand the cycle of gratitude.

Robert Emmons, a leading researcher of gratitude, defines gratitude as a recognition of the gifts that others give us, a recognition of the source of those gifts, and an appreciation of those gifts.  The good feelings that follows lead grateful people to “pay it forward”.  So, gratitude is not a simple emotion but a virtuous cycle that perpetuates giving and goodwill. If we consciously think about this cycle as we move through our day, we can foster a sense of gratitude that can transform our experience of work.

The tricky and counterintuitive part of the cycle for providers is recognizing the gifts.  Who is doing the giving? And what exactly are the gifts? Aren’t we the ones prescribing meds, offering advice and performing procedures?  We are the ones doing things in the encounters so it is easy to see why we can fail to see that the real story in healthcare is the patient’s life and thus we miss the gift that is the beauty of the lives before us.  Witnessing firsthand the struggles with serious illness is as rich and as humanizing an experience as life offers; being able to heal in this setting transforms this rich experience into a profound privilege and a gift.  These gifts can be missed if we don’t take the time to recognize them.

To best appreciate the gifts, we need to receive them properly and that means calming the stress-driven sympathetic nervous system and activating the connecting parasympathetic nervous system. We can do this with just a deep breath or two.  When calm, the Vagus nerve can be activated by receiving the gift and we get the visceral, embodied, good “feeling” that serves to physiologically reinforce the behavior. We experience this as warmth and expansiveness that facilitates our desire to reach out and give ourselves in turn.

We all know the beauty of this cycle of gratitude – leaving a patient’s room with an up-lifting sensation, feeling eager to open our heart to help our next patient. The goodwill and joyful feelings are especially useful when we have those challenging encounters that can pull us down the path of anger and frustration. This is why gratitude might be our most powerful antidote against burnout. With gas in our tank and a desire to pay it forward, we can better handle tough patches we inevitably face. Not only that, but by fostering the ability to see the beauty in our patient’s struggles, we can more easily detach from the interpersonal challenges that arise in some clinical encounters.

Gratitude is at the heart of all of the world’s great religions; I think we have all heard that “gratitude is good for us.”  In fact, there is a rich field of research with hundreds of studies that demonstrates this intuitive fact to be scientifically valid.  We can all call upon a sense of gratitude when we think about our personal lives and feel the sense of connection and humility it inspires.  If we learn to see each patient encounter as a profound privilege and a gift, our work can be transformed into a spiritual practice abounding with gratitude and purpose.

2020 has taught us much: the need for community, the importance of working together as a society and it has reaffirmed the importance of our work.  If we take the lessons from 2020 and use this Thanksgiving time to learn how to foster a sense of gratitude at work, we will indeed have much to be thankful for. Our lives and those of people we care for will be richer for it.

Lief Hass, MD
Wellness Chair – Summit Campus