scholarly journals Evolution of a Glaucoma Fellow's Surgical Training: Improvements in Tube Shunt Case Times during the Academic Year

2021 ◽  
Vol 13 (02) ◽  
pp. e119-e123
Author(s):  
Cason B. Robbins ◽  
Khalid Aldaas ◽  
Sanjay Asrani ◽  
Stuart McKinnon ◽  
David Fleischman ◽  
...  
Keyword(s):  
Medical Center ◽  
Start Time ◽  
Patient Demographics ◽  
Surgical Case ◽  
Medical Centers ◽  
Operative Case ◽  
Academic Medical ◽  
Duke University ◽  
Academic Year ◽  
Tube Shunt

Abstract Purpose The aim of the study is to report changes in tube shunt placement surgical case times for glaucoma fellows during the course of the academic year. Patients and Methods Electronic health records were retrospectively reviewed to determine patient demographics, surgical case times (defined as procedure start time to procedure end time), and glaucoma fellow involvement. Only cases with a glaucoma fellow as the primary surgeon were included. Operative case times were compared by first and second halves of the academic year (beginning in July and ending in June) using a two-tailed t-test. Results Five hundred and seventy-three individual tube shunt surgeries (385 Ahmed, 188 Baerveldt) performed by 28 glaucoma fellows (17 females, 11 males) at Duke University Eye Center and University of North Carolina Medical Center were included. Overall, case times were significantly shorter in the second half of the academic year as compared with the first (55.3 ± 17.1 minutes vs. 61.0 ± 17.4 minutes, p <0.001). Both male (57.3 ± 16.8 minutes vs. 63.2 ± 18.6 minutes, p = 0.008) and female (53.5 ± 17.3 minutes vs. 59.3 ± 16.4 minutes, p = 0.003) fellows demonstrated shorter case times over the academic year; additionally, female fellows trended toward shorter case times than male fellows in both the first half (p = 0.072) and second half (p = 0.053) of the academic year. Fellows also exhibited shorter case times with both Ahmed implants (54.1 ± 16.2 minutes vs. 59.3 ± 15.8 minutes, p = 0.002) and Baerveldt implants (57.8 ± 18.9 minutes vs. 64.2 ± 20.0 minutes, p = 0.025) cases over the academic year. Baerveldt case times were significantly longer than Ahmed cases in the first half (p = 0.028) and trended toward being longer than Ahmed cases in the second half (p = 0.070). Conclusion Across 5 years at two academic institutions, glaucoma fellows had shorter primary tube shunt surgical case times in the second half of the academic year. These findings reflect improvement in surgical efficiency throughout glaucoma fellowship. These findings should be taken into consideration when scheduling trainee surgeries at academic medical centers at different points in the academic year.

scholarly journals Coronavirus Disease 2019 (COVID-19) Clinical Trial Oversight at a Major Academic Medical Center: Approach of Michigan Medicine

2020 ◽  
Vol 71 (16) ◽  
pp. 2187-2190 ◽  
Author(s):  
Kayte Spector-Bagdady ◽  
Peter D R Higgins ◽  
Keith D Aaronson ◽  
Judy Birk ◽  
Kevin R Flaherty ◽  
...  
Keyword(s):  
Media Coverage ◽  
Medical Center ◽  
Academic Medical Center ◽  
Research Integrity ◽  
Research Issues ◽  
Randomized Controlled Clinical Trials ◽  
Subject Recruitment ◽  
Medical Centers ◽  
Academic Medical ◽  
Trial Oversight

Abstract Clinicians, eager to offer the best care in the absence of guiding data, have provided patients with coronavirus disease 2019 (COVID-19) diverse clinical interventions. This usage has led to perceptions of efficacy of some interventions that, while receiving media coverage, lack robust evidence. Moving forward, randomized controlled clinical trials are necessary to ensure that clinicians can treat patients effectively during this outbreak and the next. To do so, academic medical centers must address 2 key research issues: (1) how to effectively and efficiently determine which trials have the best chance of benefiting current and future patients and (2) how to establish a transparent and ethical process for subject recruitment while maintaining research integrity and without overburdening patients or staff. We share here the current methods used by Michigan Medicine to address these issues.

scholarly journals Supporting researchers through full-service hotline and consultation services: Success in simplicity, customization, and staffing

2020 ◽  
Vol 4 (1) ◽  
pp. 3-7
Author(s):  
Rebecca Namenek Brouwer ◽  
Emily Miller ◽  
Sunita Patil ◽  
Geeta K. Swamy ◽  
Rebbecca Moen ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Team Members ◽  
School Of Medicine ◽  
Academic Medical ◽  
High Satisfaction ◽  
Duke University ◽  
Research Questions ◽  
New Research ◽  
Consultation Services

AbstractNavigating the research domain at an academic medical center can be challenging, even for seasoned investigators. To address this, Duke University launched two initiatives: (1) a research navigation “hotline” to provide brief assistance with a variety of research questions; and (2) researcher onboarding and consultation, a one-to-one tailored offering to ensure that researchers are equipped to navigate research resources and processes effectively. The services are provided by the myRESEARCHnavigators (MRN) team, funded by Duke’s CTSA. The diverse scientific backgrounds of the six team members align well with those of the research community, allowing for a good match between the researcher and MRN team member. The MRN team answers approximately 30 questions per month, and has provided consultations to almost 400 researchers. Both services receive high satisfaction ratings (4 or 5 stars [out of 5 stars] given to 90% of hotline answers, and 99% of researcher onboarding/consultation sessions). As of July 2019, the School of Medicine has determined that the consultations are critical to their mission and have made them a requirement for new research faculty. The team will continue marketing both services to encourage adoption.

scholarly journals Race/Ethnicity, Primary Language, and Income Are Not Demographic Drivers of Mortality in Breast Cancer Patients at a Diverse Safety Net Academic Medical Center

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Divya A. Parikh ◽  
Rani Chudasama ◽  
Ankit Agarwal ◽  
Alexandar Rand ◽  
Muhammad M. Qureshi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Safety Net ◽  
Primary Language ◽  
Breast Cancer Patients ◽  
Patient Demographics ◽  
Academic Medical ◽  
Race Ethnicity

Objective. To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center.Patients and Methods. 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012.Results. There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37,p=0.006), age > 70 years (OR = 3.88, CI = 1.13–11.48,p=0.014), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06,p<0.0001).Conclusions. In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.

Factors Associated With Patient Nonattendance in Rhinology Clinics

2019 ◽  
Vol 33 (3) ◽  
pp. 317-322
Author(s):  
Benjamin N. Hunter ◽  
Brandon Cardon ◽  
Gretchen M. Oakley ◽  
Arun Sharma ◽  
Dana L. Crosby
Keyword(s):  
Chart Review ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Patient Demographics ◽  
Medical Centers ◽  
Insurance Type ◽  
Academic Medical ◽  
Included Patient

Background Nonattendance to clinical appointments is a global problem appreciated by clinicians with an ambulatory presence. There are few reports of nonattendance in otolaryngology clinics, and no reports on nonattendance for a single otolaryngology subspecialty. Objective To describe the no-show population in rhinology clinics. Methods A retrospective chart review was performed involving rhinology clinics from 2 academic medical centers in the United States. All patients who either attended their clinic appointment(s) or did not attend without previously cancelling from June 2016 to May 2017 were included. Data collected included patient demographics, appointment status, season and time of visit, insurance status, type of visit (new vs established), and provider seen. Results There were 2791 clinical appointments evaluated over a 12-month period at 2 rhinology clinics involving 4 fellowship-trained rhinologists. Ninety-two percent of patients kept their appointments, while 8% did not. Sex, season of visit, time of visit (am vs pm), type of visit, provider sex, provider location, or provider’s experience (<10 years vs ≥10 years) were not associated with patient’s attendance status. Univariate analysis showed that patient’s age ≤50 ( P = .001) and primary insurance type ( P < .001) were associated with nonattendance. Medicaid as the primary insurance type was associated with clinic nonattendance. Multivariable analysis showed that age ≤ 50 years, odds ratio (OR) 1.62 (95% confidence interval [CI] 1.14–2.30), P = .007, and primary insurance type (Medicaid: OR 3.75 [95% CI 2.58–5.45], P < .001) remained significant predictors of nonattendance. Conclusion Patients younger than 50 years and patients with Medicaid as the primary insurance types are associated with risk of missing rhinology clinic appointments. As a subspecialty, delivery of timely care and clinical efficiency could be improved by interventions directed toward improving attendance among this population.

scholarly journals An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

2019 ◽  
Vol 11 (02) ◽  
pp. e49-e53
Author(s):  
Amanda L. Ely ◽  
Mark Goerlitz-Jessen ◽  
Ingrid U. Scott ◽  
Erik Lehman ◽  
Tabassum Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Corneal Injury ◽  
Surgical Case ◽  
Anesthesia Providers ◽  
Academic Medical

Abstract Objective This article evaluates the effectiveness of an ophthalmology resident-led quality improvement (QI) initiative to decrease the incidence of perioperative corneal injury at an academic medical center Design Retrospective chart review. Methods A retrospective chart review was conducted of all surgical cases performed 6 months prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative at an academic medical center. The QI initiative (which focused on perioperative corneal injury awareness, understanding of risk factors, and presentation of an algorithm designed to prevent perioperative corneal injury) consisted of a lecture and distribution of educational materials to anesthesia providers. Data collected through the chart review included type of surgical case, presence of diabetes mellitus or thyroid disease, patient age and gender, patient positioning (supine, prone, or lateral), level of anesthesia provider training, length of surgical case, surgical service, type of anesthesia, and type (if any) of perioperative eye injury. The rates of perioperative corneal injury pre- versus post-initiative were compared. Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9 per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180 vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23), nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under the general surgery service (OR general surgery service vs. other subspecialty services = 6.50, 95% CI 2.39–24.76). Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers was associated with a significant decrease in the rate of perioperative corneal injury.

Trends in Surgical Case Volume During Pacific Partnership Missions Onboard USNS Mercy

2021 ◽  
Author(s):  
Alicia G Sykes ◽  
Jason B Brill ◽  
James D Wallace ◽  
Clara Lee ◽  
Paul R Lewis ◽  
...  
Keyword(s):  
General Surgery ◽  
Medical Center ◽  
Case Volume ◽  
Surgical Specialty ◽  
Average Case ◽  
Patient Demographics ◽  
Surgical Case ◽  
Institutional Review ◽  
Included Patient ◽  
The U.S

ABSTRACT Introduction Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions. Materials and Methods Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume. Results A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician–gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively. Conclusions Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions.

Abstract 230: Factors Associated with Postarrest Withdrawal of Life-Sustaining Therapy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anne V Grossestreuer ◽  
David F Gaieski ◽  
Benjamin S Abella ◽  
Douglas J Wiebe ◽  
Jason S Haukoos ◽  
...  
Keyword(s):  
Cardiac Catheterization ◽  
Multivariate Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multivariate Regression Analysis ◽  
Patient Demographics ◽  
Shockable Rhythm ◽  
Academic Medical ◽  
Initial Rhythm ◽  
Hospital Stays

Background: Most successfully resuscitated cardiac arrest patients do not survive to hospital discharge. Many of those have withdrawal of life sustaining therapy (WLST) as a result of a poor neurologic prognosis. Objectives: Determine characteristics of patients who have WLST post-arrest and the differences in their post-arrest care. Methods: We identified comatose post-arrest adult patients from 27 hospitals between 2000-2014. We stratified patients by whether they had WLST and analyzed demographic, arrest, and post-arrest variables. Results: Of 1439 patients analyzed, 558 (39%) patients had WLST. These patients differed in demographic, arrest, and post-arrest characteristics and treatments (Table 1). In multivariate regression analysis, patients who had WLST were more likely to have post-arrest neurology consults (OR 3.5; 95% CI: 2.3-5.3), less likely to go to the cardiac catheterization (OR 0.3; 95% CI: 0.2-0.5) or electrophysiology labs (OR 0.3; 95% CI: 0.1-0.8), and had shorter hospital stays (OR 0.9; 95% CI: 0.8-0.9). When multivariate regression was limited to patient demographics and arrest characteristics, patients with WLST were older (OR 1.01; 95% CI: 1.00-1.02), had longer downtime (OR 1.01, 95% CI: 1.01-1.02), were more likely to be female (OR: 1.5; 95% CI: 1.2-2.0), were less likely to have an initial rhythm of VF/VT (OR 0.5; 95% CI: 0.4-0.7), and were less likely to have a witnessed arrest (OR 0.7; 95% CI: 0.5-0.9). Patients were less likely to have WLST at an academic medical center (OR 0.6, 95% CI: 0.4-1.0, p=0.04). Conclusions: Comatose post-arrest patients who had WLST in the hospital were older, were more likely to have a longer arrest downtime, be female, have an initial non-shockable rhythm, have an unwitnessed arrest, and less likely to be at an academic medical center. They are more likely to have post-arrest neurology consults, less likely to go to the cardiac catheterization or electrophysiology labs, and have a shorter hospital stay.

Emergency Physician Involvement in Hospital Preparedness: A National Survey of Academic Medical Centers

2020 ◽  
pp. 1-4
Author(s):  
Kevin M. Ryan ◽  
Sina Mostaghimi ◽  
Julianne Dugas ◽  
Eric Goralnick
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Emergency Preparedness ◽  
Response Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Academic Medical Centers ◽  
Medical Centers ◽  
Academic Medical

ABSTRACT Objectives: The aim of this study was to determine the involvement of emergency medicine physicians at academic medical centers across the United States as well as their background training, roles in the hospital, and compensation if applicable for time dedicated to preparedness. Methods: A structured survey was delivered by means of email to 109 Chairs of Emergency Medicine across the United States at academic medical centers. Unique email links were provided to track response rate and entered into REDCap database. Descriptive statistics were obtained, including roles in emergency preparedness, training, and compensation. Results: Forty-four of the 109 participants responded, resulting in a response rate of 40.4%. The majority held an administrative role in emergency preparedness. Formal training for the position (participants could select more than 1) included various avenues of education such as emergency medical services fellowship or in-person or online courses. Of the participants, most (93.18%) strongly agreed that it was important to have a physician with expertise in disaster medicine assisting with preparedness. Conclusions: The majority of responding academic medical center participants have taken an active role in hospital emergency preparedness. Education for the roles varied though, often consisted of courses from emergency management agencies. Volunteering their time for compensation was noted by 27.5%.

scholarly journals Learning Experiences Within Infectious Diseases Pharmacy Residency Programs in the United States: A Cross-Sectional Survey

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Jonathan C Cho ◽  
Matthew P Crotty ◽  
Wesley D Kufel ◽  
Elias B Chahine ◽  
Amelia K Sofjan ◽  
...  
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Medical Center ◽  
Academic Medical Center ◽  
Travel Medicine ◽  
The United States ◽  
Cross Sectional ◽  
Residency Programs ◽  
Medical Centers ◽  
Academic Medical

Abstract Background Pharmacists with residency training in infectious diseases (ID) optimize antimicrobial therapy outcomes in patients and support antimicrobial stewardship (AS) programs. Although most ID residencies are accredited and assessed by certain standards, the degree to which these programs are similar is not known. Methods A 19-item, cross-sectional, multicentered, electronic survey was distributed via e-mail to pharmacy residency program directors (RPDs) of all 101 second-year postgraduate (PGY-2) ID residency programs in the United States. Results Survey responses were collected from 71 RPDs (70.3%); 64.8% were associated with an academic medical center and 97.2% focused primarily in adult ID. Rotations in the microbiology laboratory, adult AS, and adult ID consult were required in 98.6% of residency programs. Only 28.2% of responding programs required pediatric AS and pediatric ID consult rotations. Programs at academic medical centers were more likely to offer immunocompromised host ID consult (P = .003), pediatric ID consult (P = .006), and hospital epidemiology (P = .047) rotations but less frequently offered outpatient AS (P = .003), viral hepatitis clinics (P = .001), and travel medicine clinics (P = .007) rotations compared to programs at nonacademic medical centers. Residents were frequently involved in AS committees (97.2%), pharmacokinetic dosing of antimicrobials (83.1%), precepting pharmacy trainees (80.3%), and performing research projects (91.5%). Conclusions The PGY-2 ID pharmacy residency programs demonstrated consistency in required adult ID consult, antimicrobial management activities, committee service, and teaching and research opportunities. Pediatric experiences were less common. The PGY-2 ID residency programs prepare pharmacists to become antimicrobial stewards for adult patients.

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