scholarly journals 1705. Clinical Characteristics and Outcomes of Cryptococcosis in a Tertiary Care Center in Kentucky, 2005 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S624-S625
Author(s):  
Mahesh Bhatt ◽  
Julie A Ribes ◽  
Vaneet Arora ◽  
Thein Myint
Keyword(s):  
Liver Disease ◽  
Cryptococcal Meningitis ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Positive Culture ◽  
Solid Organ ◽  
India Ink

Abstract Background Cryptococcosis is an invasive fungal infection that causes pneumonia and extrapulmonary infection. This study explores its presentations, diagnostic tests, and outcome in different groups over a 12-year period at an academic medical center. Methods This was a retrospective study of the patients treated at University of Kentucky HealthCare from October 16, 2005 to October 15, 2017. Inclusion criteria were positive cryptococcal antigen (Ag), positive culture, or presence of yeast morphologically consistent with Cryptococcus on cyto- or histopathology. Patients were divided into HIV-infected, solid-organ transplant (SOT) recipients, and non-HIV/non-transplant groups. Cryptococcal meningitis comprised of either positive CSF Ag, culture, cytology or histopathology. Results A total of 114 patients were identified; 23 HIV-infected, 11 SOT recipients and 80 non-HIV/non-transplant patients (Table 1). Cryptococcus neoformans was the most common yeast isolated (91.8%). Cryptococcal meningitis was seen in 56% of total patients whereas 27% had isolated cryptococcal pneumonia (P < 0.01). Blood cultures and serum Ag were positive in 34% and 70%, respectively. Only 8.7% of HIV-infected patients had isolated pulmonary cryptococcosis compared with 36.4% in SOT recipients (P < 0.01). In patients with cryptococcal meningitis, abnormal CSF cell count, protein, or glucose was noted in 85.3%; India ink was positive in 61.3% and CSF culture was positive in 73.4% (Table 2, Figure 1). CSF cryptococcal Ag was detected in 95.6% cases if CSF cultures were positive, whereas serum Ag was positive in only 85.1% of meningitis cases. Mortality was seen in 48.6% (17/35) of patients with cirrhosis/liver disease, compared with 21.5% (17/79) of non-cirrhosis/liver disease (P = 0.003). Transplant group had 54.5% mortality compared with 26.1% in HIV group (P = 0.016). Conclusion Cryptococcal meningitis was the most common presentation for cryptococcal disease in all three groups. Isolated pulmonary disease was least common in the HIV-infected group. Inpatient mortality rate was higher in patients with cirrhosis/liver disease and transplant group compared with those without cirrhosis/liver disease and HIV group, respectively. It is imperative to rule out meningitis in immunosuppressed patients with cryptococcal pneumonia. Disclosures All authors: No reported disclosures.

scholarly journals The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

2017 ◽  
Vol 35 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Elise C. Carey ◽  
Ann M. Dose ◽  
Katherine M. Humeniuk ◽  
Yichen C. Kuan ◽  
Ashley D. Hicks ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cost Effective ◽  
Hospital Death ◽  
Personal Care ◽  
Predominately White ◽  
Dying Patients

Background: The quality of perimortem care received by patients who died at our hospitals was unknown. Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents’ families. Design: Telephone survey that included established measures and investigator-developed content. Setting: Large, tertiary care center known for high-quality, cost-effective care. Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. Intervention: None. Measurements: Participant perceptions of the decedent’s care, including symptom management, personal care, communication, and care coordination. Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents’ anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents’ illness (29%), and receiving contradictory or confusing information (33%). Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

scholarly journals Utilization and Diagnostic Yield of Neurogenetic Testing at a Tertiary Care Facility

2007 ◽  
Vol 53 (6) ◽  
pp. 1016-1022 ◽  
Author(s):  
Kerstin L Edlefsen ◽  
Jonathan F Tait ◽  
Mark H Wener ◽  
Michael Astion
Keyword(s):  
Positive Result ◽  
Diagnostic Yield ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Molecular Genetic ◽  
Tertiary Care ◽  
Care Facility ◽  
Utilization Review ◽  
Tertiary Care Facility

Abstract Background: Institutions face increasing charges related to molecular genetic testing for neurological diseases. The literature contains little information on the utilization and performance of these tests. Methods: A retrospective utilization review was performed to determine the diagnostic yield of neurogenetic tests ordered during calendar year 2005 at a large academic medical center in the western United States. Results: Overall, a relevant mutation was identified in 30.2% of the 162 patients tested and in 21.5% of the 121 probands, defined as patients for whom no mutation has been previously identified in a family member. Patients with muscle weakness (n = 65) had a mutation detected in 26.2% of all patients and 23.5% of probands (n = 51), with an estimated testing cost per positive result of $3190. Patients tested for neuropathy (n = 36) had a mutation detected in 27.8% of patients and 22.6% of probands (n = 31), with an estimated cost per positive result of $5955. Patients with chorea (n = 25) had a positive result obtained in 68% of patients and 71.4% of probands (n = 7); the estimated cost per positive test was $440. Other diagnostic categories evaluated include ataxias (n = 18; yield, 11.1%; $7620 per positive), familial stroke or dementia syndromes (n = 8; yield, 12.5%; $6760 per positive), and multisystem mitochondrial disorders (n = 10; yield, 20%; $6485 per positive). Conclusions: Expert clinicians at a tertiary care center who ordered neurogenetic tests obtained a positive result in 21.5% of patients without previously identified familial mutations. These results can be used for comparison and to help establish utilization guidelines for neurogenetic testing.

scholarly journals 161. Evaluating the Predictive Value of Blood Culture Bottle Reporting for Coagulase Negative Staphylococci-Positive Cultures: Assessing Contamination vs. True Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S105-S106
Author(s):  
Pamela Bailey ◽  
Christopher Doern
Keyword(s):  
Blood Culture ◽  
Chart Review ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Positive Culture ◽  
Antibiotic Use ◽  
Coagulase Negative Staphylococci ◽  
Culture Bottle

Abstract Background Coagulase-negative staphylococci (CoNS) are common blood culture (BCx) contaminants, but can also be causes of true blood stream infection (BSI). As a result, the clinical interpretation of CoNS positive BCx poses a significant challenge for providers and drives unnecessary antibiotic use, extended lengths of stay, and increased hospital costs. Despite these challenges, little is known about whether the number of positive BCx bottles within a set can be used to predict contamination vs. true BSI. Methods This study was conducted in an 865-bed tertiary care academic medical center in Richmond, VA. A retrospective chart review of CoNS-positive BCx from October to December 2018 was performed. Data collection included patient demographics, number of positive bottles within a set (i.e., were 1 or 2 bottles positive), care setting, antibiotic use, clinical judgement of contamination, and additional workup following the positive BCx result. Polymicrobic BCx were excluded. Results 50 patients (mean age 58.2 years, 60% male) with CoNS-positive BCx were included in this study. Forty (80%) of the cultures had only 1 of 2 BCx bottles positive within a set. 10 (20%) were positive from both bottles in the set. All patients were drawn in the Emergency Department and 90% were subsequently admitted to the hospital. Upon chart review, 47 (94%) and 3 (6%) of cultures were considered to be contaminants and real BSI, respectively. Of those judged to be contaminants, 10 (20%) were positive in both bottles within a set, and thus falsely suggested true BSI. Of the 3 judged to be true BSI, 2 (66%) were positive in 1 out of 2 bottles, and thus falsely suggested contamination. 42 (84%) patients had repeat BCx drawn following the initial positive culture, and 26 (52%) were continued on IV antibiotics. Forty (80%) of the cultures were judged contaminants by the primary medical service, and 77% stopped antibiotics (20/26) when CoNS was identified. Conclusion These data show that reporting the number of bottles which are positive within a set provides misleading information and should not be used to determine whether a culture result represents contamination or true BSI. Disclosures All authors: No reported disclosures.

Expanding Pharmacy Services With an Intern Program at an Academic Medical Center

2020 ◽  
pp. 089719002094942
Author(s):  
Hanlin Li ◽  
Vickie Powell ◽  
Demetra Tsapepas
Keyword(s):  
Patient Experience ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Hospital Pharmacist ◽  
Organ Transplant ◽  
Solid Organ ◽  
Pharmacy Services ◽  
Digital Tool

Background: Organizations that implement pharmacy services to provide patient education have reduced hospital readmissions and improved the patient experience. The term “pharmacy extender” has been used to describe pharmacy technicians and pharmacy students who alleviate the workload of a pharmacist, enhance pharmacy visibility throughout an organization, and foster professional development for the individual. Objective: The objective of this pharmacy intern-driven program is to increase pharmacy reach for medication teaching. Methods: This is a single-center, IRB-approved retrospective cohort analysis. Pharmacist-led medication teaching is currently available to select high-risk populations including solid organ transplant and bone marrow transplant recipients at our organization. Clinicians working in the pharmacy satellites have structured operational and distributional workflow responsibilities, which precludes them from directly engaging with patients. Pharmacy interns can serve as extenders that can participate in medication teaching. An internally created digital medication teaching tool will be employed to expand the pharmacy reach for medication education. Results: During the period of study, the pharmacy interns screened 3,993 patients and educated 2,868 patients. Two-thirds of the pharmacy interns that participated in the program pursued post-graduate residency or fellowship training, while the rest assumed hospital pharmacist positions. Conclusion: Deploying pharmacy interns as extenders for distribution of an internally created digital tool that provides general medication teaching has shown positive outcomes including greater pharmacy presence and visibility, better patient experience, and higher patient satisfaction. Continuous data collection and monitoring are warranted to demonstrate the benefits of the program once sustained and potentially justify more resources for further expansion.

Assessment of Tracheostomy and Laryngectomy Knowledge among Non-Otolaryngology Physicians

2019 ◽  
Vol 129 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Tsung-yen Hsieh ◽  
Leah Timbang ◽  
Maggie Kuhn ◽  
Hilary Brodie ◽  
Lane Squires
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
Basic Principles ◽  
Chi Squared ◽  
Knowledge Deficits ◽  
The Impact

Objective: Identify knowledge deficits about alternate airways (AAs) (tracheostomy and laryngectomy) among physicians across multiple specialties a tertiary institution and to assess the impact of an educational lecture on improving deficits. Methods: Study Design: Cross-sectional assessment. Setting: Academic medical center. Subjects and Methods: An anonymous 10-item, multiple choice assessment was given to physicians at a tertiary care center in the departments of Otolaryngology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, and Pediatrics. An educational lecture on AAs was presented. Scores between a pre-lecture and a 3-month post-lecture assessment were compared. Data was analyzed using ANOVA and chi-squared analysis. Results: Otolaryngology physicians scored an average of 97.8%, while non-otolaryngology physicians scored 58.3% ( P < .05). Non-otolaryngology surgical physicians scored 68.4% while non-surgical physicians were lower at 55.1% ( P < .0001). Comparing pre-lecture to post-lecture scores, all non-otolaryngology physicians improved their scores significantly from 58.3% to 86.5% ( P < .005). Non-surgical physicians had significant improvement after the instructional lecture, closing the score gap with surgical physicians for the post-lecture assessment. Discussion: The care of patients with AAs requires an understanding of their basic principles. Our findings identify significant knowledge deficits among non-otolaryngologists. Through an instructional lecture, we demonstrated improvement in knowledge among non-otolaryngology physicians and durability of the knowledge after 3 months. Conclusions: Through an instructional lecture, we found tracheostomy and laryngectomy knowledge deficits can be identified and improved upon. Periodic reinforcement of basic principles for non-otolaryngology physicians may be a promising strategy to ensure the proper care of patients with AAs.

Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India

2021 ◽  
Author(s):  
Viral Dineshchandra Vyas ◽  
Sarojini Ashok Parameswaran ◽  
Piramanayagam Paramasivan ◽  
Krishnan Sankaranarayanan ◽  
Kallipatti Ramasamy Palaniswamy ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Southern India ◽  
Solid Organ ◽  
Tertiary Care Center ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

scholarly journals 2484. Pre-Transplant Vaccination Adherence in Pediatric Solid Organ Transplant Patients at a Large Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S745-S745
Author(s):  
Eric Fela ◽  
Kaitlyn Rivard ◽  
Andrea Pallotta ◽  
Michael Spinner ◽  
Maryjoy Lepak ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Patients ◽  
Academic Medical

scholarly journals Bat Intrusions at a Tertiary Care Center, Iowa 2018–2020

2021 ◽  
Vol 1 (S1) ◽  
pp. s16-s16
Author(s):  
Mohammed Alsuhaibani ◽  
Takaaki Kobayashi ◽  
Lorinda Sheeler ◽  
Alexandra Trannel ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Infection Prevention And Control ◽  
Potential Exposure ◽  
And Control

Background: Bats are recognized as important vectors in disease transmission. Frequently, bats intrude into homes and buildings, increasing the risk to human health. We describe bat intrusions and exposure incidents in our hospital over a 3-year period. Methods: The University of Iowa Hospitals and Clinics (UIHC) is an 811-bed academic medical center in Iowa City, Iowa. Established in 1928, UIHC currently covers 209,031.84 m2 (~2,250,000 ft2) and contains 6 pavilions built between 1928 and 2017. We retrospectively obtained bat intrusion calls from the infection prevention and control program call database at UIHC during 2018–2020. We have also described the event management for intrusions potentially associated with patient exposures. Results: In total, 67 bat intrusions occurred during 2018–2020. The most frequent locations were hallways or lounges 28 (42%), nonclinical office spaces 19 (14%), and stairwells 8 (12%). Most bat intrusions (65%) occurred during the summer and fall (June–November). The number of events were 15 in 2018, 28 in 2019, and 24 in 2020. We observed that the number of intrusions increased with the age of each pavilion (Figure 1). Of 67 intrusions, 2 incidents (3%) were associated with potential exposure to patients. In the first incident, reported in 2019, the bat was captured in a patient care area and released before an investigation of exposures was completed and no rabies testing was available. Also, 10 patients were identified as having had potential exposure to the bat. Among them, 9 patients (90%) received rabies postexposure prophylaxis. In response to this serious event, we provided facility-wide education on our bat control policy, which includes the capture and safe handling of the bat, assessment of potential exposures, and potential need for rabies testing. We also implemented a bat exclusion project focused on the exterior of the oldest hospital buildings. The second event, 1 patient was identified to have potential exposure to the bat. The bat was captured, tested negative for rabies, no further action was needed. Conclusions: Bat intrusions can be an infection prevention and control challenge in facilities with older buildings. Hospitals may need animal intrusion surveillance systems, management protocols, and remediation efforts.Funding: NoDisclosures: None

scholarly journals Determination of Risk Factors Associated With Isolation of Linezolid-Resistant Strains of Vancomycin-Resistant Enterococcus

2007 ◽  
Vol 28 (12) ◽  
pp. 1382-1388 ◽  
Author(s):  
Jason M. Pogue ◽  
David L. Paterson ◽  
A. William Pasculle ◽  
Brian A. Potoski
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Horizontal Transmission ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Control Measures ◽  
Control Group ◽  
Solid Organ ◽  
Factors Associated ◽  
Vancomycin Resistant

Objective.To identify independent risk factors associated with isolation of linezolid-resistant, vancomycin-resistant Enterococcus (VRE).Design.A retrospective, case-case-control study.Setting.A tertiary care, academic medical center.Methods.VRE isolates from clinical cultures were retrospectively analyzed for linezolid resistance during our 18-month study period. Clinical data were obtained from electronic patient records, and the risk factors associated with isolation of linezolid-resistant VRE were determined by comparison of 2 case groups with a control group.Results.A total of 20% of the VRE isolates analyzed during the study period were linezolid resistant, and resistant isolates were most commonly recovered from the urine (40% of resistant isolates). Risk factors found to be associated with isolation of linezolid-resistant VRE were peripheral vascular disease and/or the receipt of a solid organ transplant, total parenteral nutrition, piperacillin-tazobactam, and/or cefepime. Only 25% of patients from whom linezolid-resistant VRE was isolated had previous linezolid exposure, and in the multivariate model this was not found to be a risk factor associated with the isolation of linezolid-resistant VRE.Conclusions.The results of this analysis suggest that there is horizontal transmission of linezolid-resistant VRE in our institution and highlight the need for improved infection control measures. Furthermore, the high incidence of linezolid-resistant VRE demands a reassessment of our empirical antibiotic selection for patients infected with VRE.

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