Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US

Abstract Introduction: The development of postgraduate programs for physician assistants (PAs) began in 1973 and by 2020 there were approximately 100 programs spread across a broad range of medical and surgical disciplines. An assessment of these programs was undertaken. Method: A non-experimental, descriptive research study was designed to obtain information on the characteristics of PA postgraduate education programs in the US. The source of information was from surveyed members of the Association of Postgraduate Physician Assistant Programs. Questions were drawn from consensus discussions. Programs that were operational in 2020 were eligible to participate. Results: Seventy-two programs were invited to the survey and 34 replied. They are geographically distributed across the US in 13 states. The respondents represent a wide range of medicine: surgery, emergency medicine, critical care, orthopaedics, hospitalist, psychiatry, oncology, primary care, pediatrics, and cardiology. Most programs are associated with an academic medical center. The curriculum includes bedside teaching, lectures, mentorship, assigned reading, procedures, simulation, and conferences. The PA fellow serves as house officer alongside physician residents and fellows. An average program length is 12 months and awards a certificate. Stipends for PA fellows are $50,000-80,000 (2020 dollars) and benefits include paid time off, health and liability insurance. About half of the programs bill for the services rendered by the PA. Over 90% of graduates are employed within two months of fellowship completion. Conclusion: A trend is underway in American medicine to include PAs in postgraduate education. PA fellowships occur across a broad spectrum of medical and surgical areas, as well as diverse institutions and organizations overseeing the programs. Most are in academic medical centers or teaching hospitals. This study expands information on PA fellowships and their operation.

Download Full-text

Are USMLE Scores Valid Measures for Chief Resident Selection?

Journal of Graduate Medical Education ◽

10.4300/jgme-d-19-00782.1 ◽

2020 ◽

Vol 12 (4) ◽

pp. 441-446

Author(s):

Elaine R. Cohen ◽

Joshua L. Goldstein ◽

Clara J. Schroedl ◽

Nancy Parlapiano ◽

William C. McGaghie ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Chief Resident ◽

Academic Medical ◽

The Us ◽

Residency Selection ◽

P 16 ◽

Usmle Step 1 ◽

Usmle Step ◽

Resident Selection

ABSTRACT Background The US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores are often used to inform a variety of secondary medical career decisions, such as residency selection, despite the lack of validity evidence supporting their use in these contexts. Objective We compared USMLE scores between non–chief residents (non-CRs) and chief residents (CRs), selected based on performance during training, at a US academic medical center that sponsors a variety of graduate medical education programs. Methods This was a retrospective cohort study of residents' USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores from 2015 to 2020. The authors used archived data to compare USMLE Step 1 and Step 2 CK scores between non-CR residents in each of the eligible programs and their CRs during the 6-year study period. Results Thirteen programs enrolled a total of 1334 non-CRs and 211 CRs over the study period. There were no significant differences overall between non-CRs and CRs average USMLE Step 1 (239.81 ± 14.35 versus 240.86 ± 14.31; P = .32) or Step 2 scores (251.06 ± 13.80 versus 252.51 ± 14.21; P = .16). Conclusions There was no link between USMLE Step 1 and Step 2 CK scores and CR selection across multiple clinical specialties over a 6-year period. Reliance on USMLE Step 1 and 2 scores to predict success in residency as measured by CR selection is not recommended.

Download Full-text

Clinical Presentation of Hepatocellular Carcinoma in African Americans vs. Caucasians: A Retrospective Analysis

Pathophysiology ◽

10.3390/pathophysiology28030026 ◽

2021 ◽

Vol 28 (3) ◽

pp. 387-399

Author(s):

Hrishikesh Samant ◽

Kapil Kohli ◽

Krunal Patel ◽

Runhua Shi ◽

Paul Jordan ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Medical Center ◽

Academic Medical Center ◽

Ethnic Disparities ◽

Surveillance Program ◽

Chi Square ◽

Vein Thrombosis ◽

Disease Characteristics ◽

Academic Medical

Hepatocellular carcinoma (HCC) remains an important form of cancer-related morbidity and mortality in the U.S. and worldwide. Previous U.S.-based studies on survival suggest ethnic disparities in HCC patients, but the complex interplay of multiple factors that contribute are still incompletely understood. Here we considered the influences of risk factors contributing towards HCC survival, including ethnic background, over ten years at a premier academic medical center with a majority (57.20%) African American (AA) population. Retrospective HCC data were collected from 2008–2018 at LSUHSC-Shreveport, an urban tertiary medical center. Data included demographics, comorbidities, liver disease characteristics, and tumor parameters. Statistical analysis was performed using Chi Square and one-way ANOVA. Results: 229 HCC patients were identified (male 78.6%). The mean HCC age at diagnosis was 61 years (SD = 7.3). Compared to non-Hispanic Caucasians (42.7%), AA patients (57.2% of total) were older at presentation, had more frequent diabetes/dyslipidemia/NAFLD (45 (34.3%) compared with 19 (19.3%) in non-Hispanic Caucasians, p = 0.02), and had a larger HCC burden at diagnosis. We conclude that compared to white patients, despite having similar BMI and MELD scores and rates of portal vein thrombosis, AA patients with HCC in our cohort were older at presentation, had a significantly increased incidence of modifiable metabolic risk factors including diabetes, higher AFP values, increased incidence of gallstones, and larger sized HCCs, and were more likely to be outside Milan criteria. These findings have important prognostic and diagnostic implications for developing a more targeted HCC surveillance program.

Download Full-text

177. Implementation of Pharmacist-Driven Penicillin Allergy Evaluation and Testing with a Focus on Bypassing Penicillin Skin Testing at an Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.221 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S95-S96

Author(s):

YoungYoon Ham ◽

Shyam Joshi ◽

Ellie Sukerman ◽

Kendall J Tucker ◽

Diana Yu ◽

...

Keyword(s):

Medical Center ◽

Skin Testing ◽

Academic Medical Center ◽

Penicillin Allergy ◽

Patient Interview ◽

Academic Medical ◽

Number Of Patients ◽

The Us ◽

Graded Challenge ◽

Negative Health Outcomes

Abstract Background Penicillin allergies are reported by approximately 10% of the US population; however, studies reveal that >90% of those patients can tolerate penicillins. Penicillin allergies are associated with negative health outcomes, both clinical and financial, due to reduced efficacy and increased adverse effects of alternative antibiotics. Patient interview, penicillin skin testing (PST) and/or an oral graded challenge can be used to evaluate penicillin allergies. Different facilities use various algorithms for testing. The objective of this project was to determine whether a pharmacist-driven penicillin allergy evaluation and testing protocol which largely bypasses PST could safely de-label patients. Methods Adult patients (≥18 years) admitted with a penicillin allergy were evaluated for eligibility between September 2019 and June 2020. Pregnant patients, critically-ill patients, and patients receiving test-invalidating medication were excluded. Patients were evaluated and tested using institutional protocols, which allowed for the majority of patients to be challenged without PST. Allergies were removed with standardized documentation, and patients were given a pamphlet and counseled to discourage relabeling. Data collected included but were not limited to, the number of patients challenged and de-labeled, number of patients who were relabeled, and number of patients whose change in allergy status resulted in change of therapy. Results Forty-eight patients were interviewed and evaluated. One patient was evaluated by PST and oral graded challenge while 27 patients underwent an oral graded challenge only. Twenty patients were de-labeled as a result of patient interview. One patient failed oral challenge with minor itching that did not require any treatment, while 27 patients passed. Forty-seven allergies were removed or modified. Two patients who were de-labeled were relabeled with no record of a new reaction. Of de-labeled patients, 50% received a penicillin following removal of the allergy. Conclusion Penicillin allergies can be evaluated and removed using a pharmacy-driven algorithm that prioritizes direct challenges when appropriate. Risks of a reaction are low, and removal leads to change in treatment in a significant portion of patients. Disclosures All Authors: No reported disclosures

Download Full-text

Hepatic Resection for Hepatocellular Carcinoma at an Academic Medical Center Is Associated with Improved Long-Term Survival

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2016.06.144 ◽

2016 ◽

Vol 223 (4) ◽

pp. S75

Author(s):

Brandon C. Chapman ◽

Alessandro Paniccia ◽

Douglas M. Overbey ◽

Patrick Hosokawa ◽

William G. Henderson ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Resection ◽

Medical Center ◽

Academic Medical Center ◽

Term Survival ◽

Long Term Survival ◽

Academic Medical

Download Full-text

Complementary and Integrative Medicine at Mayo Clinic

The American Journal of Chinese Medicine ◽

10.1142/s0192415x15500858 ◽

2015 ◽

Vol 43 (08) ◽

pp. 1503-1513 ◽

Cited By ~ 15

Author(s):

Ran Pang ◽

Shihan Wang ◽

Lin Tian ◽

Mark C. Lee ◽

Alexander Do ◽

...

Keyword(s):

Back Pain ◽

Stress Management ◽

Mayo Clinic ◽

Medical Center ◽

Academic Medical Center ◽

Psychological Disorders ◽

Management Training ◽

Stress Management Training ◽

Academic Medical ◽

The Us

Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

Download Full-text

Effect of baseline medications on response to immunotherapy in hepatocellular carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.484 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 484-484

Author(s):

Tomi Jun ◽

Sirish Dharmapuri ◽

Thomas Urban Marron ◽

Max W. Sung ◽

Celina Ang

Keyword(s):

Hepatocellular Carcinoma ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Histamine Receptor ◽

Experimental Models ◽

Secondary Outcome ◽

Advanced Hepatocellular Carcinoma ◽

Racially Diverse ◽

Academic Medical

484 Background: Immunotherapy (IO) response rates in advanced hepatocellular carcinoma (HCC) are less than 20%. The microbiome has been shown to mediate IO response in experimental models, and clinical studies have observed that antibiotics, especially prior to IO initiation, are associated with reduced IO response. We reasoned that commonly prescribed antacid medications, such as proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs), which are known to influence the microbiome, may also influence IO response. Methods: This is a retrospective chart review-based study of 95 patients with advanced HCC treated with IO at a single academic medical center. The primary outcome was overall survival (OS). The secondary outcome was overall response rate (ORR). The primary predictors were antibiotic or antacid exposure in the 60 days prior to IO. A secondary predictor was antibiotic or antacid exposure in the 30 days prior to IO. Results: The cohort was predominantly male (84%), was racially diverse (31% White, 23% Black, 23% Asian, 13% Hispanic), and had a median age of 65 years. There were 49 deaths with a median follow up of 0.96 years. The most common underlying liver diseases were HCV (49%), HBV (31%), and NASH (11%). The majority of patients had cirrhosis (80%), with a median Child Pugh score of 6. Within 60 days before IO, 25 patients received antibiotics, 40 received PPIs and 5 received H2RAs. Most patients receiving antibiotics also received a PPI (92%). The median duration of antibiotics was 5 days. Neither antibiotic nor antacid exposure within 60 or 30 days prior to IO was significantly correlated with OS in univariate or multivariate analyses, nor were they correlated with ORR. Conclusions: No significant associations between baseline exposure to antibiotics and antibiotics and OS or ORR were identified in this single-institution study. Larger observational studies or mechanistic studies are needed to clarify interactions between medications, the microbiome, and IO response. [Table: see text]

Download Full-text

Omadacycline for the Treatment of Mycobacterium abscessus Disease: A Case Series

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa415 ◽

2020 ◽

Vol 7 (10) ◽

Cited By ~ 1

Author(s):

Jeffrey C Pearson ◽

Brandon Dionne ◽

Aaron Richterman ◽

Samuel J Vidal ◽

Zoe Weiss ◽

...

Keyword(s):

Antimicrobial Agents ◽

Medical Center ◽

Academic Medical Center ◽

Case Series ◽

Mycobacterium Abscessus ◽

Academic Medical ◽

The Us ◽

Culture Positive ◽

Definitive Role

Abstract Background Omadacycline is an aminomethylcycline antimicrobial approved by the US Food and Drug Administration in 2018 for community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections. It has in vitro activity against nontuberculous mycobacteria, including Mycobacterium abscessus complex, but clinical data for this indication are lacking. Methods Omadacycline use was reviewed at an 804-bed academic medical center. Patients were included if they received omadacycline for culture-proven M abscessus disease in 2019. Results Four patients received omadacycline for the treatment of culture-positive M abscessus disease in 2019. Two patients had cutaneous disease, 1 had pulmonary disease, and 1 had osteomyelitis and bacteremia. The patients received omadacycline for a median duration of 166 days (range, 104–227) along with a combination of other antimicrobial agents. Omadacycline-containing regimens were associated with a clinical cure in 3 of 4 patients, with 1 patient improving on ongoing treatment. Omadacycline’s tolerability was acceptable for patients with M abscessus disease, with 1 patient discontinuing therapy in month 6 due to nausea. Conclusions Omadacycline is a novel oral option for the treatment of M abscessus disease, for which safe and effective options are needed. Although this case series is promising, further data are required to determine omadacycline’s definitive role in the treatment of M abscessus disease.

Download Full-text

A rationale and framework for seeking remote electronic or phone consent approval in endovascular stroke trials – special relevance in the COVID-19 environment and beyond

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016221 ◽

2020 ◽

Vol 12 (7) ◽

pp. 654-657 ◽

Cited By ~ 4

Author(s):

Ansaar T Rai ◽

Donald Frei

Keyword(s):

Informed Consent ◽

Medical Center ◽

Academic Medical Center ◽

Rural Geography ◽

Non Profit ◽

Academic Medical ◽

The Us ◽

Hub Network ◽

Legal Frameworks ◽

Special Relevance

BackgroundEnrollment in time-sensitive endovascular stroke trials can be challenging because of an inability to consent a debilitated patient. Often the legally authorized representative is not on site. Remote consent procedures in the US are inconsistent with the majority of sites shunning these approaches. The current pandemic with visitor restrictions highlights the need for enhancing these options.MethodsRemote electronic and phone consent procedures specifically for endovascular stroke trials from two comprehensive stroke centers (CSC) are presented. An overview of the genesis of informed consent procedures in the US is also included.ResultsThe two CSCs identified as Institution-1 and Institution-2 are large tertiary systems. Institution-1 is a non-profit university-affiliated academic medical center in rural geography. Institution-2 is an HCA hospital in an urban environment. Both serve patients through a spoke-and-hub network, have participated in multiple randomized endovascular stroke trials, and have successfully used these remote options for enrollment. A tiered approach is employed at both institutions with an emphasis on obtaining informed consent in person and resorting to alternatives methods when efforts to that are unsuccessful. A rationale for electronic and phone consent is included, followed by step-by-step illustration of the process at each institution.ConclusionTwo examples of remote electronic or phone consent procedures from institutions in different geographic environments and organization structures demonstrate that these options can be successfully used for enrollment in stroke trials. The current pandemic highlights the need to enhance these approaches while maintaining appropriate adherence to ethical and legal frameworks.

Download Full-text