scholarly journals Assessment of Clinical Ordering Practices of Phosphatidylethanol Monitoring for Alcohol Use at a Large Academic Medical Center

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S11-S12
Author(s):  
Thomas Herb ◽  
Carmen Gherasim ◽  
David Manthei
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Use ◽  
Medical Center ◽  
Academic Medical Center ◽  
Test Results ◽  
Negative Results ◽  
Academic Medical ◽  
Term Monitoring ◽  
Positive Results

Abstract Objectives Phosphatidylethanol (PEth) has emerged as a specific biomarker for alcohol use with superior diagnostic values compared to traditional alcohol biomarkers including urinary ethyl glucuronide (uEtG), urinary ethyl sulfate (uEtS), and carbohydrate-deficient transferrin (CDT). PEth can extend the detection window of alcohol use up to 28 days and has been dubbed a “hemoglobin A1c”-like biomarker for alcohol use. Measurement of PEth concentration in the blood has become of increasing interest in a wide variety of clinical settings including transplant evaluation, detection of chronic alcohol consumption and monitoring alcohol abstinence. Availability of PEth testing is currently limited to few reference laboratories; at our institution, PEth quickly became one of the most expensive chemistry/toxicology sendout tests. Few testing guidelines exist for PEth regarding test utilization and time intervals for appropriate repeat testing. This retrospective analysis was conducted evaluating the patterns of PEth ordering to inform best test utilization strategies. Methods A retrospective limited data set of PEth (PEth 16:0/18:1 by LC-MS/MS) test results was obtained from a large academic medical center. Concordance of the positive test results using a cutoff of 20 ng/mL for repeat testing within 7, 14 and 28 days was analyzed. Results 3,739 distinct results from 1,957 patients was obtained. The median age of patients was 57 years (range 19-94). Males accounted for 58.4% (1,142 patients) of the testing. The overall positivity rate was 23.3% (median concentration 188.5 ng/mL), with 52% of positive results suggesting moderate alcohol consumption (20 – 200 ng/mL) while the remaining 48% reflected heavy alcohol consumption or chronic alcohol use (>200 ng/mL). 588 patients (30%) had multiple PEth results, including 150 patients with ≥ 5 results and 36 patients with ≥ 10 results. Long term monitoring of alcohol use in pre- and post- transplant patients (n=36) with ≥ 10 results revealed that 52.7% had all negative results, 5.6% all positive results, and 41.7% with mixed results included a subset (25%) initially positive and subsequently negative results monitored for up to 2 years. Analysis of two consecutive tests ordered within 7 (n=96), 14 (n=205) and 28 days (n=411) revealed that 90%, 82.9% and 83.7% of the results had the same interpretation with an average change in concentration of 15.2 ng/mL 35.9 ng/mL, and 35.4 ng/mL, respectively. Of the 10% observed changes within 7 days, the majority accounted for expected PEth 16:0/18:1 elimination. Conclusions Our data suggests that long-term monitoring of alcohol use with PEth may be helpful in the surveillance of alcohol abstention or alcohol relapse that can assist in prioritizing patients for liver transplant. To improve PEth test utilization (and decrease expensive sendout testing), PEth should not be ordered less than 7 days apart. Instead, recent alcohol use may be monitored with traditional biomarkers (uEtG/uEtS).

scholarly journals COVID-19 Admission Screening, and Assessment of Infectiousness at an Academic Medical Center, Iowa 2020

2021 ◽  
pp. 1-19
Author(s):  
Mohammed Alsuhaibani ◽  
Takaaki Kobayashi ◽  
Alexandra Trannel ◽  
Stephanie Holley ◽  
Oluchi J. Abosi ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical History ◽  
Rt Pcr ◽  
University Of Iowa ◽  
Past Infection ◽  
Admission Screening ◽  
Academic Medical ◽  
The University ◽  
Positive Results

Abstract Objective: Patients admitted to the hospital may unknowingly carry SARS-CoV-2 and hospitals have implemented SARS-CoV-2 admission screening. However, because SARS-CoV-2 RT-PCR may remain positive for months after infection, positive results may represent active or past infection. We determined the prevalence and infectiousness of patients who were admitted for reasons unrelated to COVID-19 but tested positive on admission screening. Methods: We conducted an observational study at the University of Iowa Hospitals & Clinics from July 7 to October 25, 2020. All patients admitted without suspicion of COVID-19 infection were included and medical records of those with a positive admission screening test were reviewed. Infectiousness was determined using patient history, PCR cycle threshold (Ct) value, and serology. Results: A total of 5,913 patients were screened and admitted for reasons unrelated to COVID-19. Of these, 101 had positive admission RT-PCR results. Thirty-six patient were excluded because they had respiratory signs/symptoms on admission on chart review. Sixty-five patients (1.1%) did not have respiratory symptoms. A total of 55 patients had Ct values available and were included in this analysis. The median age was 56 years, and (51%) were male. Our assessment revealed that 23 patients (42%) were likely infectious. The median duration of in-hospital isolation was five days for those likely infectious and two days for those deemed non-infectious. Conclusions: COVID-19 infection was infrequent among patients admitted for reasons unrelated to COVID-19. An assessment of the likelihood of infectiousness using clinical history, RT-PCR Ct values, and serology may help discontinue isolation and conserve resources.

Implementation of a pharmacist-provided pharmacogenomics service in an executive health program

2021 ◽  
Author(s):  
Ina Liko ◽  
Lisa Corbin ◽  
Eric Tobin ◽  
Christina L Aquilante ◽  
Yee Ming Lee
Keyword(s):  
Health Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Test Results ◽  
Sample Collection ◽  
Team Members ◽  
University Of Colorado ◽  
Academic Medical ◽  
Previous Medication ◽  
Selection Of

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center. Summary As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient’s current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement. Conclusion The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.

scholarly journals Independent risk factors for chronic illicit substance use during pregnancy

2020 ◽  
Vol 16 (5) ◽  
pp. 351-356
Author(s):  
Manuel C. Vallejo, MD, DMD ◽  
Robert E. Shapiro, MD ◽  
Mitchell W. Lippy, BS ◽  
Christa L. Lilly, PhD ◽  
Leo R. Brancazio, MD
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Medical Center ◽  
Academic Medical Center ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Academic Medical ◽  
Multiple Variable ◽  
History Of ◽  
Independent Risk Factors

Objective: We aimed to determine the incidence of chronic illicit substance use during pregnancy and to identify associated risk factors.Design: A 2-year time-matched retrospective maternal quality control database (n = 4,470) analysis of parturients with chronic illicit substance use compared to controls.Setting: A tertiary academic medical center located in a rural setting.Results: The rate of chronic illicit substance use was 1.95 percent. Demographic factors associated with chronic illicit substance use in pregnancy-included lower body mass index (BMI; OR: 0.93; 95 percent CI: 0.89-0.96, p 0.0001), higher gravidity (OR: 1.24; 95 percent CI: 1.13-1.36, p 0.0001), higher parity (OR: 1.38; 95 percent CI: 1.22-1.57, p 0.0001), and more live births (OR: 1.30; 95 percent CI: 1.16-1.46, p 0.0001). A history of smoking (OR: 10.51; 95 percent CI: 5.69-19.42, p 0.0001), alcohol use (OR: 48.98; 95 percent CI: 17.33-138.40, p 0.0001), anxiety (OR: 1.88; 95 percent CI: 1.16-3.05, p = 0.01), depression (OR: 2.44; 95 percent CI: 1.55-3.85, p = 0.0001), transfer on admission (OR: 2.12; 95 percent CI: 1.16-3.87, p = 0.01), payor insurance (OR: 2.12, 95 percent CI: 2.10-5.04, p 0.0001), and Apgar scores 7 at 1 minute (OR: 0.50; 95 percent CI: 0.25-1.00, p = 0.049) were significant. Multiple variable logistic regression-revealed BMI, smoking, alcohol use, and Apgar score 7 at 1 minute as significant factors.Conclusions: Awareness of these factors can assist in identifying and treating parturients with chronic illicit substance use.

scholarly journals Impact of a Multidisciplinary Long-Term Opioid Therapy Safety Program at a Military Tertiary Academic Medical Center

2021 ◽  
Author(s):  
Jennifer L Jaskiewicz ◽  
Conor B Garry ◽  
Andrew J Ernst ◽  
Jacob H Cole ◽  
Miranda L Allen ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Therapy ◽  
Prescribing Patterns ◽  
Therapy Outcomes ◽  
Academic Medical ◽  
Anonymized Data ◽  
Systematic Education ◽  
Safety Metrics

ABSTRACT Objective In light of the ongoing opioid crisis, Naval Medical Center Portsmouth (NMCP) created the Long-Term Opioid Therapy Safety (LOTS) program to reduce risks and improve long-term opioid therapy outcomes. Our primary outcome was change in compliance with the recommended safety metrics. Design This is a retrospective cohort study performed at NMCP, a large military academic medical center providing comprehensive medical care to DoD beneficiaries. The NMCP LOTS program provides both patient and provider narcotic education as well as medical record auditing. The NMCP LOTS program promotes adherence to published CDC, the DVA, and DoD guidelines. Methods Anonymized data were compiled each fiscal quarter and were analyzed retrospectively. Adult patients prescribed opioids for at least 90 days without a gap of 30 days between prescriptions were included in this study. The investigators recorded and reported provider compliance with LOTS metrics over the same period. Results Compliance with the recommended safety metrics improved. We noted a decrease in the number of long-term opioid patients, concurrent benzodiazepine prescriptions, and patients prescribed greater than 90 morphine equivalents per day during the observation period. The number of naloxone prescriptions for LOTS patients also increased, reflecting improved guideline adherence. Conclusion Systematic education and feedback to providers are effective in creating a system and culture of opioid reduction, safe opioid prescribing, and system accountability. This article presents a comprehensive approach to modifying prescribing patterns of long-term opioids in a large healthcare system.

scholarly journals Experience With Pretravel Testing for SARS-CoV-2 at an Academic Medical Center

2021 ◽  
Vol 8 ◽  
pp. 237428952110102
Author(s):  
Katherine L. Imborek ◽  
Matthew D. Krasowski ◽  
Paul Natvig ◽  
Anna E. Merrill ◽  
Daniel J. Diekema ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Severe Acute Respiratory Syndrome ◽  
Reverse Transcriptase ◽  
Medical Center ◽  
Academic Medical Center ◽  
Immunoglobulin M ◽  
Chain Reaction ◽  
Academic Medical ◽  
Polymerase Chain ◽  
Positive Results

International travel has been a significant factor in the coronavirus disease 2019 pandemic. Many countries and airlines have implemented travel restrictions to limit the spread of the causative agent, severe acute respiratory syndrome coronavirus-2. A common requirement has been a negative reverse-transcriptase polymerase chain reaction performed by a clinical laboratory within 48 to 72 hours of departure. A more recent travel mandate for severe acute respiratory syndrome coronavirus-2 immunoglobulin M serology testing was instituted by the Chinese government on October 29, 2020. Pretravel testing for severe acute respiratory syndrome coronavirus-2 raises complications in terms of cost, turnaround time, and follow-up of positive results. In this report, we describe the experience of a multidisciplinary collaboration to develop a workflow for pretravel severe acute respiratory syndrome coronavirus-2 reverse-transcriptase polymerase chain reaction and immunoglobulin M serology testing at an academic medical center. The workflow primarily involved self-payment by patients and preferred retrieval of results by the patient through the electronic health record patient portal (Epic MyChart). A total of 556 unique patients underwent pretravel reverse-transcriptase polymerase chain reaction testing, with 13 (2.4%) having one or more positive results, a rate similar to that for reverse-transcriptase polymerase chain reaction testing performed for other protocol-driven asymptomatic screening (eg, inpatient admissions, preprocedural) at our medical center. For 5 of 13 reverse-transcriptase polymerase chain reaction positive samples, the traveler had clinical history, prior reverse-transcriptase polymerase chain reaction positive, and high cycle thresholds values on pretravel testing consistent with remote infection and minimal transmission risk. Severe acute respiratory syndrome coronavirus-2 immunoglobulin M was performed on only 24 patients but resulted in 2 likely false positives. Overall, our experience at an academic medical center shows the challenge with pretravel severe acute respiratory syndrome coronavirus-2 testing.

scholarly journals The Use of an Electronic Health Record Patient Portal to Access Diagnostic Test Results by Emergency Patients at an Academic Medical Center: Retrospective Study (Preprint)

2019 ◽  
Author(s):  
Brody Foster ◽  
Matthew David Krasowski
Keyword(s):  
Diagnostic Test ◽  
Laboratory Tests ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Portal ◽  
Test Results ◽  
Patient Portals ◽  
Radiology Reports ◽  
Academic Medical ◽  
Laboratory Results

BACKGROUND Electronic health record (EHR) patient portals provide a means by which patients can access their health information, including diagnostic test results. Little is known about portal usage by emergency department (ED) patients. OBJECTIVE The study aimed to assess patient portal utilization by ED patients at an academic medical center using account activation rates along with the rates of access of diagnostic test results (laboratory results and radiology reports), analyzing the impact of age, gender, and self-reported patient race. METHODS This institutional review board–approved retrospective study was performed at a 60,000-visits-per-year university-based ED. We utilized EHR data reporting tools to examine EHR portal activation and utilization for all patients who had at least one ED encounter with one or more diagnostic tests performed between October 1, 2016, and October 1, 2017. The total dataset for laboratory testing included 208,635 laboratory tests on 25,361 unique patients, of which 9482 (37.39%) had active portal accounts. The total dataset for radiologic imaging included 23,504 radiology studies on 14,455 unique patients, of which 5439 (37.63%) had an active portal account. RESULTS Overall, 8.90% (18,573/208,635) of laboratory tests and 8.97% (2019/22,504) of radiology reports ordered in the ED were viewed in the patient portal. The highest rates of viewing of laboratory and radiology results were seen for those who were female, were aged 0 to 11 years (parent or guardian viewing by proxy) and 18 to 60 years, and self-reported their race as Caucasian or Asian. The lowest rates were for those who were teenagers, aged older than 81 years, African American/black, and Hispanic/Latino. Infectious disease, urinalysis, and pregnancy testing constituted the highest number of laboratory tests viewed. Magnetic resonance imaging reports were viewed at higher rates than computed tomography or x-ray studies (P<.001). Approximately half of all the diagnostic test results accessed by patients were reviewed within 72 hours of availability in the patient portal (laboratory results: 9904/18,573, 53.32% and radiology reports: 971/2019, 48.1%). On the other extreme, 19.9% (3701/18,573) of laboratory results and 31.6% (639/2019) of radiology reports were viewed more than 2 weeks after availability in the portal. CONCLUSIONS The data highlight the relatively low use of a patient portal by ED patients and existing disparities between patient groups. There can be wide lag time (months) between result/report availability and access by patients. Opportunities for improvement exist for both activation and more robust utilization of patient portals by ED patients.

Sign in / Sign up

Export Citation Format

Share Document