scholarly journals QOLP-19. INSOMNIA IN BRAIN TUMOR PATIENTS: ASSESSING NEEDS IN NEURO-ONCOLOGY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii178-ii179
Author(s):  
Kelcie Willis ◽  
Scott Ravyts ◽  
Autumn Lanoye ◽  
Ashlee Loughan
Keyword(s):  
Brain Tumor ◽  
Sleep Disturbance ◽  
Pharmacological Treatment ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Brain Tumor ◽  
Academic Medical ◽  
Fatigue Severity ◽  
Negative Side Effects ◽  
The Relationship

Abstract BACKGROUND Insomnia is a prevalent consequence of cancer diagnosis and treatment. In primary brain tumor (PBT) patients specifically, insomnia has been rated as one of the most severe symptoms and linked with other negative side effects, such as increased fatigue and emotional distress. Despite these findings, research has consistently omitted PBT patients in understanding the detailed effects and treatment for insomnia. METHODS Adult PBT patients (N=74) completed anonymous surveys at routine neuro-oncology appointments at an NCI-designated academic medical center. The surveys included validated measures of insomnia (ISI & PSQI), fatigue (BFI), and other original items (e.g., How would you describe your feelings towards medication treatment for insomnia?). The current investigation aimed to assess: 1) the prevalence of clinically elevated symptoms of insomnia, 2) the relationship between sleep disturbance and daytime fatigue and distress, and 3) patients’ preferences for pharmacological and non-pharmacological treatment for insomnia in PBT patients. RESULTS Of the sampled PBT patients, 38% reported significant sleep disturbance as measured by the PSQI. Moreover, 23% endorsed clinically elevated, moderate-severe symptoms of insomnia as measured by the ISI. Excessive worrying (r =.31) and bad dreams (r =.29, p< .05) were both associated, though not predictive of insomnia severity (p >.05). Insomnia symptoms predicted increased fatigue severity, F(1,72) =52.60, β=.65, p< .001, R2 =.42. Of the patients with clinical insomnia, 59% felt that their symptoms were not well-managed by their medical team; 53% expressed interest in pharmacological treatment and 47% in non-pharmacological treatment. CONCLUSIONS The prevalence and consequences of insomnia identified in PBT patients are similar to that of other cancers, yet the majority of PBT patients with insomnia reported their symptoms were poorly managed. Though there was slight preference for pharmacological treatment, the sizeable proportion of those interested in non-pharmacological treatments warrants investigations into such therapies (e.g., CBT-I) in medical settings

scholarly journals 1575. Vancomycin Loading Doses and Nephrotoxicity on Medicine Teaching Services

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S575-S575
Author(s):  
Phillip Wagner ◽  
Jon Arnold ◽  
Kathleen R Sheridan
Keyword(s):  
Drug Exposure ◽  
Standard Dose ◽  
Medical Center ◽  
Academic Medical Center ◽  
Kidney Injury ◽  
Loading Dose ◽  
Academic Medical ◽  
Trough Concentrations ◽  
Seriously Ill Patients ◽  
The Relationship

Abstract Background IDSA guidelines recommend the usage of a loading dose when using vancomycin for seriously ill patients to rapidly achieve adequate trough concentrations. While the relationship between vancomycin and nephrotoxicity is the focus of many studies, and with the strength of that relationship still debated, few studies have examined the relationship between vancomycin loading doses and nephrotoxicity. Methods We performed a retrospective cohort study examining vancomycin dosing for internal medicine teaching services’ patients over the 2014–15 academic year at one academic medical center. We generated a list of all hospitalized patients aged 18–85 who received vancomycin and were admitted to a teaching service. Patient data were extracted from the inpatient EMR via manual chart review. Patients were excluded if their pretreatment calculated glomerular filtration rate (GFR) was less than 50 mL/minute, if they received less than three doses of vancomycin, or if their initial dose was subtherapeutic (<10 mg/kg). Nephrotoxicity was determined by 7-day acute kidney injury (AKI) rate. Patients in the loading dose (>20 mg/kg) cohort were compared with those in the standard dose cohort (10–20 mg/kg). Our primary modeling used multi-variable logistic regression with AKI as our outcome of interest. Results 438 of the initial 804 patients were enrolled. The loading dose (n = 365, 83%) and standard dosing (n = 73, 17%) cohorts were not significantly different regarding demographics, GFR, nephrotoxic drug exposure, total vancomycin received, trough levels, or comorbidities, and were only significantly different regarding body mass index (BMI). The 7-day AKI rate was not significantly different between the two arms (6.3% in the standard dosing arm and 8.2% in the loading dose arm P = 0.6). AKI rate significantly increased in both arms in the setting of concurrent piperacillin–tazobactam and vancomycin administration (OR 2.5, P = .04). There was no association between BMI and AKI. Conclusion Few studies have examined the relationship between nephrotoxicity and vancomycin loading doses. The results of this study provide evidence that the use of loading doses is not significantly associated with increased 7-day AKI rate. Disclosures All authors: No reported disclosures.

Impact of an innovative partnership in patient care between an academic medical center department of pharmacy and a school of pharmacy

2019 ◽  
Vol 76 (24) ◽  
pp. 2070-2076
Author(s):  
Mary-Haston Vest ◽  
Mary G Petrovskis ◽  
Scott W Savage ◽  
Nicole R Pinelli ◽  
Ashley L Pappas ◽  
...  
Keyword(s):  
Patient Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Residency Programs ◽  
Pharmacy Department ◽  
Academic Medical ◽  
American Society ◽  
The Impact ◽  
The Relationship

Abstract Purpose Pharmacy departments and schools of pharmacy have long held professional affiliations. However, the success of each entity is often not interdependent and aligned. In 2010, our institutions found ourselves in a position where the complementary motivations of each aligned to support a more meaningful and committed engagement, leading to the development of the Partnership in Patient Care. The impact of the partnership was evaluated 7 years postimplementation, and both the successes realized and the lessons learned are described. Summary The partnership provided many advantages to our pharmacy department and the school of pharmacy. This initial iteration of the partnership was a strong proof of concept that an intentional approach to the relationship between a school of pharmacy and a pharmacy department can lead to substantive improvements in a wide array of meaningful outcomes. We experienced an increase in the number of student rotation months completed, growth in the American Society of Health-System Pharmacists–accredited residency programs, and enhanced clinical services. However, the partnership was not without challenges. For instance, lack of a formalized tracking method made certain outcomes difficult to track. Conclusion The purposeful establishment of the Partnership in Patient Care, built on the needs of a school of pharmacy and an academic medical center pharmacy department, allowed our institutions to develop an intertwined mission and vision. Over the initial years of the partnership, many successes were realized and lessons were learned. Both the successes and the challenges are serving as the foundation for future iterations of the partnership.

scholarly journals Elevated FGF23 Levels Are Associated with Impaired Calcium-Mediated Suppression of PTH in ESRD

2010 ◽  
Vol 24 (12) ◽  
pp. 2406-2407
Author(s):  
James B. Wetmore ◽  
Peter Santos ◽  
Jonathan D. Mahnken ◽  
Ron Krebill ◽  
Rochelle Menard ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Medical Center ◽  
Fibroblast Growth Factor 23 ◽  
Academic Medical Center ◽  
Positive Association ◽  
Calcium Sensing ◽  
Academic Medical ◽  
High Calcium ◽  
Gland Function ◽  
The Relationship

Abstract Context: The positive association of elevated fibroblast growth factor-23 (FGF23) with PTH levels in the setting of secondary hyperparathyroidism is paradoxical to the purported effects of FGF23 to suppress PTH secretion. Objective: We used dynamic calcium-mediated suppression of PTH levels in hemodialysis (HD) patients to determine the relationship between FGF23 levels and parathyroid gland function. Design: HD patients with elevated PTH were washed out of vitamin D analogs and/or calcimimetics and then exposed them to a high-calcium dialysate bath designed to suppress PTH. Setting: The study was conducted at an outpatient HD unit of an academic medical center. Participants: Eighteen maintenance HD patients with elevated PTH levels participated in the study. Main Outcome Measures: Ionized calcium (iCa), PTH, and FGF23 levels were measured during HD. The slope of the relationship between iCa and PTH (a marker of parathyroid gland mass) and the iCa level required for a 50% reduction in PTH were determined, and the association of these with FGF23 levels was determined. Results: Increased baseline log FGF23 levels were associated with putative alterations in gland mass as estimated by significantly shallower slopes of the iCa/PTH suppression curves (P = 0.0004), but there was no association between FGF23 and calcium sensing as measured by ionized Ca associated with a 50% suppression of PTH (P = 0.38). FGF23 levels decreased significantly during HD, but this change was not correlated with decrements in either renal phosphate or PTH. Conclusions: High FGF23 levels may be a marker for parathyroid gland hyperplasia in HD patients. Acute reductions in neither PTH nor renal phosphate during dialysis correlated with PTH suppression.

scholarly journals The Influence of Household Income on Survival following Posterior Fossa Tumor Resection at a Large Academic Medical Center

2020 ◽  
Author(s):  
Rachel Blue ◽  
Donald K. Detchou ◽  
Ryan Dimentberg ◽  
Kaitlyn Shultz ◽  
Michael Spadola ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Brain Tumor ◽  
Posterior Fossa ◽  
Household Income ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tumor Resection ◽  
Academic Medical ◽  
Significant Difference

Abstract Objectives The present study examines the effect of median household income on mid- and long-term outcomes in a posterior fossa brain tumor resection population. Design This is a retrospective regression analysis. Setting The study conducted at a single, multihospital, urban academic medical center. Participants A total of 283 consecutive posterior fossa brain tumor cases, excluding cerebellar pontine angle tumors, over a 6-year period (June 09, 2013–April 26, 2019) was included in this analysis. Main Outcome Measures Outcomes studied included 90-day readmission, 90-day emergency department evaluation, 90-day return to surgery, reoperation within 90 days after index admission, reoperation throughout the entire follow-up period, mortality within 90 days, and mortality throughout the entire follow-up period. Univariate analysis was conducted for the whole population and between the lowest (Q1) and highest (Q4) socioeconomic quartiles. Stepwise regression was conducted to identify confounding variables. Results Lower socioeconomic status was found to be correlated with increased mortality within 90 postoperative days and throughout the entire follow-up period. Similarly, analysis between the lowest and highest household income quartiles (Q1 vs. Q4) demonstrated Q4 to have significantly decreased mortality during total follow-up and a decreasing but not significant difference in 90-day mortality. No significant difference in morbidity was observed. Conclusion This study suggests that lower household income is associated with increased mortality in both the 90-day window and total follow-up period. It is possible that there is an opportunity for health care providers to use socioeconomic status to proactively identify high-risk patients and provide additional resources in the postoperative setting.

scholarly journals Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Diana L. Franco ◽  
Molly B. Disbrow ◽  
Allon Kahn ◽  
Laura M. Koepke ◽  
Lucinda A. Harris ◽  
...  
Keyword(s):  
Medical Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Intestinal Bacterial Overgrowth ◽  
Academic Medical ◽  
Small Intestine Bacterial Overgrowth ◽  
Small Intestinal ◽  
The Relationship

Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO). Proton pump inhibitor (PPI) use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from 1263 consecutive patients undergoing upper endoscopy at a tertiary medical center. Aspirates were collected thought out the third and fourth portions of the duodenum, and cultures were considered to be positive for SIBO if they produced more than 100,000 cfu/mL. Culture analysis of duodenal aspirates identified SIBO in one-third of patients. A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder.

Hyperlipidemia in noise-induced hearing loss

2007 ◽  
Vol 137 (4) ◽  
pp. 603-606 ◽  
Author(s):  
Ning-Chia Chang ◽  
Ming-Lung Yu ◽  
Kuen-Yao Ho ◽  
Chi-Kung Ho
Keyword(s):  
Hearing Loss ◽  
Medical Center ◽  
Academic Medical Center ◽  
Laboratory Data ◽  
Noise Induced Hearing Loss ◽  
Academic Medical ◽  
Southern Taiwan ◽  
And Gender ◽  
One Year ◽  
The Relationship

Objectives To assess the influence of hyperlipidemia on the development of noise-induced hearing loss (NIHL). Study Design This case-control study analyzed data from the Department of Preventive Medicine at one academic medical center in southern Taiwan. Subjects and Methods We collected the laboratory data from routine health examinations administered to workers who were exposed to noise greater than 85 dBA over a one-year period. We analyzed the relationships of cholesterol and triglyceride levels with NIHL. Results A total of 4071 cases were analyzed. After adjusting for age and gender, hypertriglyceridemia was found to be related to NIHL (aOR = 1.281; 95% CI, 1.088–1.507), but hypercholesterolemia was not (aOR = 0.951; 95% CI, 0.795–1.138). Conclusions This study, one of the largest to date to study the relationship between hyperlipidemia and NIHL, found that individuals with hypertriglyceridemia are at greater risk of NIHL. On the basis of this finding, workers exposed to high noise levels should be educated on control of triglyceride levels to help reduce their risk of NIHL.

Serious illness communication practices in glioblastoma care at an academic medical center.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 28-28
Author(s):  
Lauren Reed-Guy ◽  
Tyler D. Alexander ◽  
Gregory Biggiani ◽  
Stephen P. Miranda ◽  
Nina O'Connor
Keyword(s):  
High Performance ◽  
Hospital Admissions ◽  
Medical Center ◽  
Performance Status ◽  
Academic Medical Center ◽  
Median Number ◽  
Primary Brain Tumor ◽  
Average Life Expectancy ◽  
Code Status ◽  
Academic Medical

28 Background: Glioblastoma (GBM) is an aggressive primary brain tumor with a disease course marked by both cognitive and physical decline. Early conversations about end-of-life (EOL) preferences are important given the average life expectancy of 14 months. Little is known about patterns of communication in GBM. Objective: To describe current practices surrounding EOL conversations in GBM patients at an academic medical center. Methods: We reviewed the medical records of 240 patients treated for GBM at the University of Pennsylvania who died between 2017 and 2019. We systematically identified and characterized EOL conversations, as defined by documented discussions of prognosis, goals of care, EOL planning and/or code status. Results: Patients in this study were predominantly male, white, privately insured and had relatively high performance status (median KPS 80 at initiation of therapy). Median survival was 487 days and 96% of patients received both chemotherapy and radiation. Nearly all patients (96%) had at least one EOL conversation documented. The median number of documented conversations per patient was 4. The first EOL conversation occurred at a median of 24 days after diagnosis (range 0 to 3,883) and 362 days before death (0 to 2,401). The last EOL conversation occurred at a median of 32 days before death (0 to 1,514). EOL conversations took place earlier among older patients, with each additional year of age at diagnosis associated with a first conversation 8 days earlier (95% CI: -12 to -4 days; p<0.01). At least one EOL conversation occurred at an outpatient visit for 89% of patients; 33% had conversations during hospital admissions; and 38% had EOL conversations via telephone. Medical oncology was the most common specialty to document EOL conversations (89% of patients), followed by palliative care (19%), radiation oncology (13%) and neurosurgery (10%). Conclusions: EOL conversations appear to have occurred relatively early and often, but further work is needed to evaluate the quality of documented discussions and to determine whether this pattern is unique to this single center or widespread. The variety in provider specialty and conversation setting reflects the complexity of the care environment in GBM.

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