scholarly journals Trends in Incidence of Norovirus-associated Acute Gastroenteritis in 4 Veterans Affairs Medical Center Populations in the United States, 2011–2015

2019 ◽  
Vol 70 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Scott Grytdal ◽  
Hannah Browne ◽  
Nikail Collins ◽  
Blanca Vargas ◽  
Maria C Rodriguez-Barradas ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Gastroenteritis ◽  
Medical Center ◽  
Seasonal Pattern ◽  
Adult Population ◽  
Diagnostic Testing ◽  
The United States ◽  
Incidence Rates ◽  
Veterans Affairs ◽  
Stool Specimens

Abstract Background Norovirus is an important cause of epidemic acute gastroenteritis (AGE), yet the burden of endemic disease in adults has not been well documented. We estimated the prevalence and incidence of outpatient and community-acquired inpatient norovirus AGE at 4 Veterans Affairs Medical Centers (VAMC) (Atlanta, Georgia; Bronx, New York; Houston, Texas; and Los Angeles, California) and examined trends over 4 surveillance years. Methods From November 2011 to September 2015, stool specimens collected within 7 days of AGE symptom onset for clinician-requested diagnostic testing were tested for norovirus, and positive samples were genotyped. Incidence was calculated by multiplying norovirus prevalence among tested specimens by AGE-coded outpatient encounters and inpatient discharges, and dividing by the number of unique patients served. Results Of 1603 stool specimens, 6% tested were positive for norovirus; GII.4 viruses (GII.4 New Orleans [17%] and GII.4 Sydney [47%]) were the most common genotypes. Overall prevalence and outpatient and inpatient community-acquired incidence followed a seasonal pattern, with higher median rates during November–April (9.2%, 376/100 000, and 45/100 000, respectively) compared to May–October (3.0%, 131/100 000, and 13/100 000, respectively). An alternate-year pattern was also detected, with highest peak prevalence and outpatient and inpatient community-acquired norovirus incidence rates in the first and third years of surveillance (14%–25%, 349–613/100 000, and 43–46/100 000, respectively). Conclusions This multiyear analysis of laboratory-confirmed AGE surveillance from 4 VAMCs demonstrates dynamic intra- and interannual variability in prevalence and incidence of outpatient and inpatient community-acquired norovirus in US Veterans, highlighting the burden of norovirus disease in this adult population.

scholarly journals Incidence of Norovirus-Associated Acute Gastroenteritis in Four Veteran’s Affairs Medical Center Populations in the United States, 2011–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S317-S317
Author(s):  
Scott Grytdal ◽  
Hannah Browne ◽  
Nikail Collins ◽  
Blanca Vargas ◽  
Maria Rodriguez-Barradas ◽  
...  
Keyword(s):  
New York ◽  
Los Angeles ◽  
Acute Gastroenteritis ◽  
Medical Center ◽  
Diagnostic Testing ◽  
The United States ◽  
Outpatient Visits ◽  
Annual Range ◽  
The Usa ◽  
Stool Specimens

Abstract Background In the USA, norovirus is an important cause of epidemic acute gastroenteritis (AGE) as well as a leading cause of pediatric AGE. However, the burden of sporadic norovirus disease in US adults has not been well-documented. Our objective was to estimate the incidence of outpatient visits and hospitalizations for community-acquired norovirus AGE at four Veterans Affairs Medical Centers (VAMCs) and their associated outpatient clinics in Atlanta, GA; Bronx, New York; Houston, TX; and Los Angeles, CA. Methods From November 2011 to September 2015, stool specimens collected for clinician-requested diagnostic testing within 7 days of AGE symptom onset and with reported vomiting or diarrhea were tested for norovirus by real-time RT-PCR and positive samples were genotyped by Sanger sequencing. Incidence of norovirus-associated outpatient visits and hospitalizations were calculated by multiplying the prevalence of norovirus among tested specimens by AGE-coded outpatient encounters and inpatient discharges, and dividing by the unique patients served at each VAMC. Results 1,620 stool specimens were tested from all 4 sites. Seven percent of outpatient (n = 795) samples (annual range: 3%–10%; range by site: 3%–10%) and 6% of
(n = 825) samples from hospitalized patients tested positive for norovirus (annual range: 3%–8%; range by site: 3%–10%). Forty-four percent of norovirus-positive specimens were typed as GII.4 Sydney. Seventy-four percent of norovirus-positive specimens were collected between November and April. From 2011 to 2015, outpatient norovirus incidence was 250/100,000 population (annual range: 129 to 426/100,000; range by site: 87 to 428/100,000), and the incidence of norovirus hospitalizations was 28/100,000 population (annual range: 19 to 39/100,000; range by site: 14 to 57/100,000). By age group and setting, the highest incidence was observed among 45- to 64-year-old outpatients (370/100,000 population), and 85+-year-old inpatients (63/100,000 population). Conclusion This study provides estimates of the incidence of norovirus AGE outpatient visits and hospitalizations across multiple years among a geographically distributed VA population, highlighting the substantial burden of norovirus in US adults. Disclosures All authors: No reported disclosures.

scholarly journals Weight Mobility and Obesity in a Representative Sample of the US Adult Population

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Deanna J. M. Isaman ◽  
Amy E. Rothberg
Keyword(s):  
Representative Sample ◽  
Medical Expenditure Panel Survey ◽  
Adult Population ◽  
The United States ◽  
Incidence Rates ◽  
Medical Expenditure ◽  
The Us ◽  
Prevalence Of Obesity ◽  
One Year ◽  
Overweight Or Obesity

Background. Despite the attention given to the prevalence of obesity, surprisingly little is known about the incidence or reduction of obesity. We report the 1-year incidence and remission of obesity in a representative sample of the US population. Methods. Individuals from the Medical Expenditure Panel Survey (MEPS) panel 17 were classified into standard obesity categories at enrollment and one year later. Incidence rates were calculated by age. Results. Although the overall prevalence of obesity remained nearly constant, remission rates from obesity (stratified by age) ranged from 11 to 27% while incidence rates ranged from 6 to 16%. For almost all age levels, the proportion of individuals leaving an obese or overweight state was greater than or equal to the proportion who progressed to a more severe level of overweight or obesity. Overall, 36% of adults lost at least 2.5 kg/m2 in the one-year period; only 8% gained 2.5 kg/m2 or more. Individuals less than 25 years of age had higher rates of leaving overweight (23% versus <16%) and obesity (27% versus 24%) classifications than people of other ages. Conclusions. Prevalence rates of obesity are well documented in the United States, but incidence is understudied. Public health efforts that target young people with overweight or obesity may yield the greatest benefit.

Ethnic and Racial Difference In H.Pylori Infection In Patients With ITP Treated At A MAJOR Tertiary Medical Center In LOS Angeles

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3548-3548
Author(s):  
Caitlin M O'Neill ◽  
Ulysses Gomez ◽  
Ilene C Weitz ◽  
Casey O'Connell ◽  
Howard Liebman
Keyword(s):  
United States ◽  
Los Angeles ◽  
Racial Differences ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
The United States ◽  
Response To Therapy ◽  
Additional Patient ◽  
Newly Diagnosed ◽  
H Pylori

Abstract Background Infection with Helicobacter pylori has been implicated as an etiologic agent for the development of immune thrombocytopenia (ITP). In a systematic review of the medical literature Stasi and colleagues reported wide regional variation in the prevalence of H. pylori infection in ITP patients with significant differences in improvement in platelet count with infection eradication. The largest report on H.pylori infection in ITP patients diagnosed in the United States found a lower prevalence of infection (21.6%) than the reported seroprevalence (32.5%) for the general United States population.1 Only 1 of 15 treated patients responded eradication of their infection.1 Based upon this report the American Society of Hematology ITP guidelines do not recommend routine H. pylori testing during the evaluation of newly diagnosed patients. Los Angeles County-University of Southern California Medical Center is the largest healthcare provider in the metropolitan Los Angeles region. It services a large and ethically diverse patient population. Screening for H.pylori infection in newly diagnosed and previously diagnosed ITP patients was begun as a routine part of the diagnostic algorithm in 2008. We initiated a retrospective review of H.pylori infection in patients screened during this period. Results At the time of this report the medical records of 80 ITP patients (M/F: 22/58) have been reviewed. 68 (F/M: 52/16) patients, 51 with 1o ITP and 17 with 2ry ITP, were screened for H.pylori. The median age of the screened patients was 50 yrs (23 to 85 yrs). Patients were screened with either the H. pylori stool antigen (46 pts; 65%) or H. pylori Breath test (10 pts; 16%). 12 patients (19%) were only screened for H.pylori antibodies. Of the screened patients, 29/68 (42.6%) tested positive for H. pylori. However, there were significant ethnic and racial differences in the prevalence of infection (Table ). 27 of the 29 positive patients were treated for their infection. H. Pylori eradication was documented in 20 of 22 (91%). An additional patient was successfully treated with a second course of antibiotics. Response to therapy could not be assessed in 14 of the 27 treated patients due to treatment with concomitant ITP medications. Of the 13 patients who could be evaluated for response using IWG criteria, there were 4 (30.8%) complete responses, 1 (7.7%) partial response and no response in 8 (61.5%). All complete responders were treated within 2 months of initial presentation. At the time of this report only 3 of the 29 patients remain on ITP treatment. Conclusion There are significant ethnic and racial differences in the prevalence of H. pylori infection in ITP patients diagnosed in the greater Los Angeles metropolitan region. Despite earlier reports from New York and Miami, early identification and treatment of H. pylori infected may result in remissions up to a third of patients. 1. Michel M et al. Blood 2004; 103: 890-896. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Incidence of Medically-Attended Norovirus-Associated Acute Gastroenteritis in Four Veteran’s Affairs Medical Center Populations in the United States, 2011-2012

PLoS ONE ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. e0126733 ◽  
Author(s):  
Scott P. Grytdal ◽  
David Rimland ◽  
S. Hannah Shirley ◽  
Maria C. Rodriguez-Barradas ◽  
Matthew Bidwell Goetz ◽  
...  
Keyword(s):  
United States ◽  
Acute Gastroenteritis ◽  
Medical Center ◽  
The United States ◽  
Veteran's Affairs

Changing Epidemiology ofClostridium difficile-Associated Disease in Children

2007 ◽  
Vol 28 (11) ◽  
pp. 1233-1235 ◽  
Author(s):  
Lacey Benson ◽  
Xiaoyan Song ◽  
Joseph Campos ◽  
Nalini Singh
Keyword(s):  
Emergency Department ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Temporal Trends ◽  
Outpatient Setting ◽  
Incidence Rates ◽  
Steady Increase ◽  
Ofclostridium Difficile ◽  
Number Of Patients ◽  
Stool Specimens

Objective.To determine temporal trends in the incidence rate forClostridium difficile-associated disease (CDAD) in a pediatric patient population.Methods.We performed an observational, retrospective cohort study that included children who visited or were admitted to Children's National Medical Center during the period from July 2001 through June 2006. The CDAD incidence rates were determined and examined for changes over time using the Poisson regression method.Results.A total of 513 patients whose stool specimens tested positive forC. difficiletoxin were identified. Of these patients, 61% were children aged 2 years or older. The proportion of patients with CDAD in this age group has steadily increased from 46% in 2001 to 64% in 2006. Largely as a result of an increasing number of cases of community-associated CDAD, the incidence of CDAD increased significantly in the outpatient setting, particularly in the emergency department (1.18 cases per 1,000 visits in 2001 vs 2.47 cases per 1,000 visits in 2006;P= .02). The incidence among inpatients decreased during the study period (1.024 cases per 1,000 patient-days in 2001 vs 0.680 cases per 1,000 patient-days in 2006;P= .004). In the neonatal intensive care unit,C. difficile toxinwas detected in stool specimens collected from 22 patients aged from 15 days to 6 months.Conclusion.This study revealed a steady increase in the number of patients seen in the emergency department with community-acquired CDAD. Findings from this study suggest that the characteristics of CDAD in children—a population that has not been considered to be at high risk for this disease in the past—are changing. Further investigations are warranted to explore deviations from the established burdens of the disease and patient risk factors.

scholarly journals Utilizing Telemedicine During Outbreak Events to Reduce Exposure Risk

2020 ◽  
Vol 41 (S1) ◽  
pp. s427-s428
Author(s):  
Anjali Bisht ◽  
Stacey Weinstein ◽  
Daniel Uslan
Keyword(s):  
Los Angeles ◽  
Public Awareness ◽  
Diagnostic Testing ◽  
Signs And Symptoms ◽  
The United States ◽  
Chief Complaint ◽  
Contact Tracing ◽  
Medical Attention ◽  
Mmr Vaccine ◽  
Potential Exposure

Background: As of October 2019, the United States has seen the greatest number of annual measles cases reported since 1992, of which 2 outbreaks originated in Los Angeles County, California. Media reports and public awareness during outbreak events can result in large numbers of worried well patients or patients with outbreak mimics seeking medical attention. In densely populated cities, utilizing alternative approaches to in-person physician appointments can be beneficial to decrease both the overburden of healthcare resources as well as the spread of potential virus. During these measles outbreaks, we employed the use of telemedicine visits to facilitate triage and determination of in-person examination and testing needs. Methods: During the measles outbreak periods, patients who contacted the patient call center at our institution requesting an appointment for fever, rash, or expressing concerns for acute measles infection were instead routed for a telemedicine visit with a physician. All patients were all seen by the same physician, who was trained in internal medicine and pediatrics. During the telemedicine visit, patients were assessed for signs and symptoms consistent with acute measles based on CDC definition. If there was high enough clinical suspicion to warrant testing for measles, infection prevention coordinated logistics with clinic staff, including ensuring the use of appropriate personal protective equipment (PPE), end-of-day appointment scheduling, and appropriate diagnostic testing. Results: During this outbreak timeline, 7 patients were seen through telemedicine visits with ages ranging 13 months to 49 years. Also, 6 patients were scheduled due to a chief complaint of acute rash and 1 was due to a potential exposure to measles. Of 7 patients, 4 had received 1 dose of the MMR vaccine, and the remaining 3 were immune, unvaccinated, or had unknown immunity. The unvaccinated patient was further tested for measles but was IgM negative. Of those with chief complaint of rash, the diagnosis was determined to be some form of nonmeasles viral exanthem, allergic dermatitis/eczema, or hives. The exposed patient was deemed to be asymptomatic. Conclusions: During an outbreak, patients presenting to clinics with suspected measles symptoms can cause tremendous disruption, including concerns about exposure of staff and patients, need for contact tracing, and anxiety. Utilizing telemedicine appointments aided the management of patients during this outbreak by shifting physician evaluation outside the clinic. When evaluating suspect measles cases during an outbreak with patients who do not require further levels of care, telemedicine can prove to be useful in reducing the burden of potential exposure to others in the community and to the healthcare system.Funding: NoneDisclosures: None

scholarly journals QOL-57. SOUTHERN CALIFORNIA KAISER PERMANENTE PEDIATRIC NEURO-ONCOLOGY PROGRAM DEVELOPMENT

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii441-iii441
Author(s):  
Hung Tran
Keyword(s):  
Los Angeles ◽  
Southern California ◽  
Medical Center ◽  
Pediatric Neurosurgery ◽  
The United States ◽  
Tumor Board ◽  
Oncology Patients ◽  
Kaiser Permanente ◽  
Monthly Basis ◽  
Health Maintenance

Abstract KEY MESSAGE Standardization of care for subspecialty patients require centralization and support across multi-disciplinary groups within the Kaiser Permanente medical group, which is a large health maintenance organization (HMO) in the United States. BACKGROUND Prior to the development of a Pediatric Neuro-Oncology program, Southern California Kaiser Permanente pediatric neuro-oncology patients were routinely referred to respective regional academic centers for consultation. The process was not standard across the region, resulting in additional costs and differences in treatment recommendations, potentially affecting outcomes. METHODS A Pediatric Neuro-Oncology program was established, July 2017, based at the Kaiser Permanente Los Angeles Medical Center (LAMC), consisting of pediatric neuro-oncology, pediatric neurosurgery, pediatric neuro-radiology, pediatric radiation oncology, and pediatric neuro-oncology case management. RESULTS A Pediatric Neuro-Oncology tumor board was established to meet on a bi-monthly basis. Pediatric neuro-oncology patients across the Southern California now have their magnetic resonance imaging (MRI) reviewed by the same pediatric neuro radiologists. Neuropathology is standardized and sent to Children’s Hospital Los Angeles and reviewed at the molecular neuropathology tumor board attended by the pediatric neuro-oncologist. Cases discussions regarding the patients include the regional pediatric neurosurgeons, the pediatric radiation oncologists, and the pediatric neuro-oncologist, and treatment plans are recommended and recorded by the case manager. CONCLUSIONS Centralization of care has allowed for more consistent and standard care across the Southern California Region, but requires support from multi-disciplinary groups.

scholarly journals Patient Satisfaction and Trust in Telemedicine during the COVID-19 Pandemic (Preprint)

2021 ◽  
Author(s):  
Sharon Orrange ◽  
Arpna Patel ◽  
Wendy Jean Mack ◽  
Julia Cassetta
Keyword(s):  
Patient Satisfaction ◽  
Los Angeles ◽  
Rank Order ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Related Factors ◽  
Significant Positive Association ◽  
Patients Satisfaction ◽  
Technical Issues

BACKGROUND Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient or visit-related factors and trust play when in-person visits are eliminated. OBJECTIVE To examine correlates of patients’ satisfaction with a telemedicine visit. METHODS In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged 18 years and above who completed a telemedicine visit between March 10th and April 17th, 2020 were invited for a survey (n=1624). Measures included patient-demographics, degree of interpersonal trust in patient-physician relationships using the” Trust in Physician Scale,” and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. RESULTS Of 1,624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (47.4%) or satisfied (35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with significant correlation with trust in physician score were technical issues with the telemedicine visit (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47) (all P<0.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=0.02), and successful face to face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). CONCLUSIONS There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed. CLINICALTRIAL IRB Approval University of Southern California July 2020 HS-20-00479

Website Accessibility: U.S. Veterans Affairs Medical Centers as a Case Study

2018 ◽  
Vol 81 (4) ◽  
pp. 440-461 ◽  
Author(s):  
Norman E. Youngblood ◽  
Michael Brooks
Keyword(s):  
Medical Center ◽  
Information Source ◽  
The United States ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Section 508 ◽  
Wcag 2.0 ◽  
Accessibility Issues ◽  
Veterans Affairs Medical Centers

The Internet is a critical eHealth/eGovernment information source, and the U.S. Department of Veterans Affairs operates the United States’ largest integrated health care system. This case study used machine-based accessibility testing to assess accessibility for 116 VA Medical Center websites, based on U.S. Section 508 standards and international WCAG 2.0 guidelines. While we found accessibility issues on each website analyzed, problems were generally limited. Notable exceptions included PDF accessibility and fixed-text sizes. The study’s results offer implications for practitioners (accessibility problems likely overlooked and ways to check accessibility) and educators, particularly the need to better integrate accessibility into the curriculum.

scholarly journals Analysis of SARS-CoV-2 Genomes from Southern California Reveals Community Transmission Pathways in the Early Stage of the US COVID-19 Pandemic

2020 ◽  
Author(s):  
Wenjuan Zhang ◽  
John Paul Govindavari ◽  
Brian Davis ◽  
Stephanie Chen ◽  
Jong Taek Kim ◽  
...  
Keyword(s):  
New York ◽  
Los Angeles ◽  
Local Community ◽  
Early Stage ◽  
Medical Center ◽  
New York State ◽  
The United States ◽  
Genomic Diversity ◽  
York State ◽  
The Us

AbstractGiven the higher mortality rate and widespread phenomenon of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) within the United States (US) population, understanding the mutational pattern of SARS CoV-2 has global implications for detection and therapy to prevent further escalation. Los Angeles has become an epicenter of the SARS-CoV-2 pandemic in the US. Efforts to contain the spread of SARS-CoV-2 require identifying its genetic and geographic variation and understanding the drivers of these differences. For the first time, we report genetic characterization of SARS-CoV-2 genome isolates in the Los Angeles population using targeted next generation sequencing (NGS). Samples collected at Cedars Sinai Medical Center were collected from patients with confirmed SARS-CoV-2 infection. We identified and diagnosed 192 patients by our in-house qPCR assay. In this population, the highest frequency variants were in known mutations in the 5’UTR, AA193 protein, RdRp and the spike glycoprotein. SARS-CoV-2 transmission within the local community was tracked by integrating mutation data with patient postal codes with two predominant community spread clusters being identified. Notably, significant viral genomic diversity was identified. Less than 10% of the Los Angeles community samples resembled published mutational profiles of SARS-CoV-2 genomes from China, while >50% of the isolates shared closely similarities to those from New York State. Based on these findings we conclude SARS-CoV-2 was likely introduced into the Los Angeles community predominantly from New York State but also via multiple other independent transmission routes including but not limited to Washington State and China.

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