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 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).

Use of Age and Medical Comorbidity to Assess Long-term Other-cause Mortality Risk in a Cohort of Men Undergoing Prostate Biopsy at an Academic Medical Center

Urology ◽  
2017 ◽  
Vol 100 ◽  
pp. 169-174
Author(s):  
Hal D. Kominsky ◽  
Michael Bashline ◽  
Daniel Eun ◽  
Michel A. Pontari ◽  
Jack H. Mydlo ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Prostate Biopsy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medical Comorbidity ◽  
Academic Medical

scholarly journals Acinetobacter Infections and Outcomes at an Academic Medical Center: A Disease of Long-Term Care

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Jennifer Townsend ◽  
An Na Park ◽  
Rita Gander ◽  
Kathleen Orr ◽  
Doramarie Arocha ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Long Term Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Isolates ◽  
University Hospital ◽  
Term Care ◽  
Academic Medical ◽  
Resistance Patterns

Abstract Background.  Our study aims to describe the epidemiology, microbial resistance patterns, and clinical outcomes of Acinetobacter infections at an academic university hospital. This retrospective study analyzed all inpatient clinical isolates of Acinetobacter collected at an academic medical center over 4 years. The data were obtained from an Academic tertiary referral center between January 2008 and December 2011. All consecutive inpatients during the study period who had a clinical culture positive for Acinetobacter were included in the study. Patients without medical records available for review or less than 18 years of age were excluded. Methods.  Records were reviewed to determine source of isolation, risk factors for acquisition, drug resistance patterns, and clinical outcomes. Repetitive sequence-based polymerase chain reaction of selected banked isolates was used to determine patterns of clonal spread in and among institutions during periods of higher infection rates. Results.  Four hundred eighty-seven clinical isolates of Acinetobacter were found in 212 patients (in 252 admissions). Patients with Acinetobacter infections were frequently admitted from healthcare facilities (HCFs) (59%). One hundred eighty-three of 248 (76%) initial isolates tested were resistant to meropenem. One hundred ninety-eight of 249 (79.5%) initial isolates were multidrug resistant (MDR). Factors associated with mortality included bacteremia (odds ratio [OR] = 1.93, P = .024), concomitant steroid use (OR = 2.87, P < .001), admission from a HCF (OR = 6.34, P = .004), and chronic obstructive pulmonary disease (OR = 3.17, P < .001). Conclusions.  Acinetobacter isolates at our institution are frequently MDR and are more common among those who reside in HCFs. Our findings underline the need for new strategies to prevent and treat this pathogen, including stewardship efforts in long-term care settings.

scholarly journals Evaluation of intramuscular olanzapine and ziprasidone in the medically ill

2021 ◽  
Vol 11 (1) ◽  
pp. 6-11
Author(s):  
Seema M. Patel ◽  
Ericka L. Crouse ◽  
James L. Levenson
Keyword(s):  
Second Generation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Torsades De Pointes ◽  
Prescribing Patterns ◽  
Medically Ill ◽  
White Males ◽  
Academic Medical ◽  
Second Generation Antipsychotics ◽  
Record Review

Abstract Introduction Despite the paucity of studies evaluating short-acting parenteral second-generation antipsychotics in the medically ill, their use in this population has increased. The purpose of this study was to characterize the use of IM olanzapine and ziprasidone in the medically ill at an academic medical center. Methods This is a retrospective medical record review of all patients who received IM olanzapine or ziprasidone on nonpsychiatric inpatient units at a large academic medical center from August 1, 2015 to July 31, 2017. The primary endpoint characterized the indication for use. Secondary endpoints included safety, effectiveness, and prescribing patterns. Results After exclusion criteria, a total of 100 patients were included in this study, predominantly white males with a mean age of 56 years. Seventy-four percent of patients received IM ziprasidone and 26% received IM olanzapine. The most common indications for use were agitation of nonpsychotic origin (40%) and delirium (33%). Patients received IM olanzapine and ziprasidone when their use was contraindicated (26.9% vs 9.5%, respectively). Discussion Intramuscular second-generation antipsychotics are increasingly being used in the medically ill for delirium and agitation. Our study confirms these were the most common indications for IM second-generation antipsychotic use in this population. Additionally, their use appeared to be well-tolerated, and no patient developed Torsades de Pointes even when combined with other agents that putatively increase QTc. Given the retrospective, single-center, nonrandomized design of this study, the safety and effectiveness of these parenteral second-generation antipsychotics in common causes of acute agitation should continue to be further evaluated.

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

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
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