Lost in transition: resident and fellow training and experience caring for young adults with chronic conditions in a large United States’ academic medical center

Abstract Background The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance. Methods We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC). Results Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs. Conclusions Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.

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Factors Associated with Delay in Presentation to the Hospital for Young Adults with Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000443242 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 10-14 ◽

Cited By ~ 7

Author(s):

Lester Y. Leung ◽

Louis R. Caplan

Keyword(s):

Young Adults ◽

Ischemic Stroke ◽

Time Window ◽

Medical Center ◽

Academic Medical Center ◽

Stroke Severity ◽

Delayed Presentation ◽

Stroke Subtype ◽

Academic Medical ◽

Presentation Methods

Objectives: Young adults with ischemic stroke may present late to medical care, but the reasons for these delays are unknown. We sought to identify factors that predict delay in presentation. Methods: We performed a retrospective cohort study of adults aged 18-50 admitted to a single academic medical center between 2007 and 2012. Results: Eighty six of 141 (61%) young adults with ischemic stroke presented at the health center more than 4.5 h after stroke onset. Diabetes was associated with delays in presentation (p = 0.033, relative risk (RR) 1.4 (95% CI 1.1-1.8)), whereas systemic cancer was associated with early presentations (p = 0.033, RR 0.26 (95% CI 0.044-1.6)). Individuals who were single were more likely to present late than those who were married or living with a partner (p = 0.0045, RR 1.7 (95% CI 1.3-2.2)). Individuals who were unemployed were more likely to present late than those who were employed or in school (p = 0.020, RR 1.4 (95% CI 1.1-1.8)). Age (dichotomized as 18-35 and 36-50), race, home medications, other medical conditions (including common stroke mimics in young adults), and stroke subtype were not determinants of delay in presentation, although there was a trend toward delayed presentations in women (p = 0.076) and with low stroke severity (dichotomized as National Institutes of Health Stroke Scale (NIHSS) ≤5 and NIHSS >5, p = 0.061). Conclusions: A majority of young adults with ischemic stroke presented outside the time window for intravenous fibrinolysis. Diabetes, single status, and unemployed status were associated with delayed presentation.

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1223 7 Years' Retrospective Study of Helicobacter pylori Therapy Prescription Patterns in an Urban Academic Medical Center in the United States

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000594420.51605.0e ◽

2019 ◽

Vol 114 (1) ◽

pp. S683-S683

Author(s):

Christina Lin ◽

Salina Lee

Keyword(s):

United States ◽

Helicobacter Pylori ◽

Retrospective Study ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Prescription Patterns ◽

Academic Medical

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

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.76 ◽

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%.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz387 ◽

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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Care Coordination Program for Children With Complex Chronic Conditions Discharged From a Rural Tertiary-Care Academic Medical Center

Hospital Pediatrics ◽

10.1542/hpeds.2019-0323 ◽

2020 ◽

Vol 10 (8) ◽

pp. 687-693

Author(s):

Clayten L. Parker ◽

Bennett Wall ◽

Dmitry Tumin ◽

Rhonda Stanley ◽

Lana Warren ◽

...

Keyword(s):

Care Coordination ◽

Chronic Conditions ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Complex Chronic Conditions ◽

Academic Medical

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Reliability and Construct Validity of the Complexity Compression Questionnaire

Journal of Nursing Measurement ◽

10.1891/1061-3749.22.2.291 ◽

2014 ◽

Vol 22 (2) ◽

pp. 291-301 ◽

Cited By ~ 1

Author(s):

Ronda G. Hughes ◽

Linda Fridlington ◽

Polly Ryan

Keyword(s):

United States ◽

Factor Analysis ◽

Organizational Change ◽

Construct Validity ◽

Medical Center ◽

Academic Medical Center ◽

Time Frame ◽

Factor Solution ◽

Health Records ◽

Academic Medical

Background and Purpose: The purpose of the study was to evaluate the reliability and construct validity of the Complexity Compression Questionnaire (CCQ), a 28-item instrument designed to explain nurses’ experiences when assuming multiple responsibilities in a compressed time frame. Methods: Data were obtained from 607 registered nurses in an academic medical center in the midwestern United States who participated in a larger study on system-wide organizational change involving upgrading electronic health records. Results: Cronbach’s alpha for the 26-item CCQ, was .91. Exploratory factor analysis supported a 5-factor solution that explained 53.6% of the variance. Conclusions: The CCQ may be a useful tool for measurement of the effects of organizational change on the complexity of the work of nurses.

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