scholarly journals 760. Assessment of DEXA Scan Ordering Among Infectious Disease Providers at a Large Tertiary-Care Urban Academic Center in the Midwest

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S339
Author(s):  
Rebecca Nirmal Kumar ◽  
Mary Clare Masters ◽  
Karen Krueger
Keyword(s):  
Infectious Disease ◽  
Tertiary Care ◽  
Clinic Visit ◽  
Mineral Density ◽  
Osteoporosis Screening ◽  
Academic Center ◽  
Large Tertiary Care ◽  
Care Guidelines ◽  
Prevalence Of Osteoporosis ◽  
Patient Barriers

Abstract Background Osteoporosis is compromised bone strength that predisposes to fracture. It can be diagnosed by Dual-energy x-ray absorptiometry (DEXA) measurement of bone mineral density (BMD). Persons with HIV (PWH) are at higher risk for the development of osteoporosis. As such, the HIV Medicine Association’s (HIVMA) primary care guidelines recommend DEXA screening for all HIV-infected postmenopausal women and men aged ≥50 years. The purpose of this study was to asses the frequency of DEXA utilization within a tertiary-care urban academic center in the Midwest and to identify prevalence of osteoporosis. Methods A representative sample PWH age ≥50 from our institution’s outpatient infectious disease (ID) clinic were included. All subjects had at least one clinic visit in the last year, were on antiretroviral therapy (ART), and virally suppressed. Unblinded chart review was performed to assess if DEXA was ordered, was DEXA ordered by an ID physician, was DEXA completed, results of DEXA, and whether patients were on a tenofovir disoproxil fumarate (TDF)-containing regimen. Results 225 charts were reviewed. 186 (83%) patients were men, with a median age of 58 (range of 50–85). DEXA scans were ordered on 39 (17%) patients, 9 (23%) of which were ordered by their ID provider. Twenty-eight (72%) DEXA scans were performed. Of scans completed, 11 (39%) diagnosed osteoporosis, 15 (54%) osteopenia, and 2 (7%) showed normal BMD. Of all charts reviewed, 29 (13%) were on TDF-containing regimens. Of those individuals with diagnosed abnormal BMD (26), only 1 (4%) was on a TDF-containing regimen. Conclusion Despite HIVMA’s recommendation for osteoporosis screening in PWH, only 17% of eligible patients with well-controlled HIV in our clinic had been referred for DEXA. Of those who had undergone DEXA screening, nearly all (93%) had abnormal BMD. Further investigation is necessary to explore provider and patient barriers for osteoporosis screening in PWH. Disclosures All authors: No reported disclosures.

Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center

2019 ◽  
Vol 129 (4) ◽  
pp. 369-375
Author(s):  
Caitlin Bertelsen ◽  
Janet S. Choi ◽  
Anna Jackanich ◽  
Marshall Ge ◽  
Gordon H. Sun ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Tertiary Care ◽  
Surgical Care ◽  
Safety Net ◽  
Clinic Visit ◽  
Level Of Evidence ◽  
Sociodemographic Differences ◽  
Academic Center ◽  
Safety Net Hospital ◽  
Type Of Surgery

Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c

Improved mortality in Staphylococcus aureus bacteremia with the involvement of antimicrobial stewardship team and infectious disease consultation

2019 ◽  
Vol 40 (8) ◽  
pp. 932-935 ◽  
Author(s):  
Jacqueline E. Sherbuk ◽  
Dayna McManus ◽  
Jeffrey E. Topal ◽  
Maricar Malinis
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Retrospective Study ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Disease Consultation ◽  
Academic Center ◽  
Infectious Diseases Consultation

AbstractA retrospective study was conducted to evaluate the value of the antimicrobial stewardship team (AST) combined with infectious diseases consultation (IDC) on management and outcomes of Staphylococcus aureus bacteremia (SAB) in a tertiary-care academic center. Involvement of AST or IDC was associated with reduced mortality of SAB.

Abstract 130: Do Demographic Differences Persist in a Large Radial Artery Access Center for Cardiac Catheterization?

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ankitkumar Patel ◽  
Kunal Chaudhry ◽  
Rajesh Kabadi ◽  
Travante Cartwright ◽  
Ankita Patel ◽  
...  
Keyword(s):  
Renal Failure ◽  
Radial Artery ◽  
Cardiac Catheterization ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Access Site ◽  
Demographic Differences ◽  
Data Registry ◽  
Academic Center ◽  
Large Tertiary Care

Background: Though cardiac catheterization via the radial artery (RA) as compared to the femoral artery (FA) access site is on the rise, most centers perform less than 10% cases via RA based on the National Cardiovascular Data Registry. RA is associated with lower rates of complications; however, in smaller centers it has been reported to be underutilized in women and elderly patients. We investigate what demographic differences exist in a large RA volume center. Methods: A retrospective chart review assessed all cardiac catheterization cases performed at a large tertiary care academic center from 2010-2011 (n=5344). Access site (RA/FA) is defined as the site of successful vascular entry. Case demographics were collected. Results: The RA was utilized in one-fifth of cases. RA patients had the same percentage males and Whites as FA access (Table 1). RA patients were younger, more likely to have commercial insurance, diabetes and hypertension. FA patients had more renal failure. The mean body mass index (BMI) was higher in the RA group. This was driven by a higher likelihood of obese patients (BMI >30) undergoing RA access than FA access. Conclusion: RA access is utilized more often in patients with younger age, diabetes, hypertension and obese BMIs. FA access is used more often in renal failure patients perhaps due to concern about contrast load.

scholarly journals Prevalence of Osteoporosis and Osteopenia Status among Nepalese Population using Calcaneal Ultrasonography Method

2019 ◽  
Vol 15 (4) ◽  
pp. 249-255
Author(s):  
Satyajit Bagudai ◽  
Hari Prasad Upadhayay
Keyword(s):  
Tertiary Care ◽  
Density Measurement ◽  
Cross Sectional Study ◽  
Healthy Population ◽  
Mineral Density ◽  
Cross Sectional ◽  
Policy Makers ◽  
Rehabilitative Care ◽  
Prevalence Of Osteoporosis ◽  
Apparently Healthy

Background: A recent worldwide upsurge in the fracture incidence due to osteoporosis has underlined this underdiagnosed and undertreated condition. An awareness regarding the preventive, curative and rehabilitative care as well as a proper health policy is the need of hour. This requires a proper database of prevalence rate. This study aimed to find out the prevalence of osteoporosis and osteopenia by screening the bone health status in an apparently healthy population of Nepal. Methods: A cross sectional study was conducted among 465 apparently healthy subjects of either gender in three tertiary care health centers of Nepal for bone mineral density measurement by calcaneal ultrasonography. Results: The mean+SD of age among 465 patients was 45.47+14 years, including 43.2 % male and 56.8 % females. The prevalence of osteoporosis andosteopenia was 22.4% and 60.6% respectively. Our finding showed that prevalence of osteoporosis increases with age among either gender. Conclusions: The prevalence of osteoporosis in Nepalese population was high in comparison to other countries. There is no significant association of osteoporosis with females in comparison to males. The prevalence was increasing with age in either gender. These findings will help in creating a proper database of this condition in Nepal, helping the population,physicians as well as policy makers to have a proper address to this global emerging health problem.

scholarly journals Osteoporosis among Postmenopausal Women Attending the Orthopedics Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Sunil Panta ◽  
Madhu Neupane ◽  
Shrawan Kumar Thapa ◽  
Kalyan Sapkota
Keyword(s):  
Postmenopausal Women ◽  
Fragility Fracture ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
Prevalence Of Osteoporosis

Introduction: Osteoporosis and resulting fracture is a major public health concern worldwide. With increase in life expectancy, osteoporosis and fragility fracture is expected to be more prevalent. It is associated with high patient morbidity, while hip and vertebral fractures have high mortality. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to find out the prevalence of osteoporosis among postmenopausal women visiting a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted among 89 postmenopausal women attending at Orthopedic Outpatient Department of Bharatpur Hospital from 1st January 2019 to 30th December 2019 with postmenopausal status. The ethical clearance was taken from the Institutional Review Committee of Bharatpur Hospital. Convenience sampling technique was used. Bone Mineral Density was estimated with dual energy x-ray absorptiometry scan Statistical Package for Social Science was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 89 postmenopausal women, 29 (32.58%) (Confidence Interval = 32.48-32.68) women had osteoporosis. The mean age and Bone Mineral Density were 62.16±8.17 years and 0.968±0.14 g/cm² respectively. Conclusions: Prevalence of osteoporosis was high. Women with history of fragility fracture are at increased risk of another fragility fracture. It is hence necessary to have awareness programs and early screening to minimize the magnitude of morbidity and mortality associated with osteoporosis.

scholarly journals Providing safe care for patients in the coronavirus disease 2019 (COVID-19) era: A case series evaluating risk for hospital-associated COVID-19

2021 ◽  
pp. 1-7
Author(s):  
Elizabeth B. Habermann ◽  
Aaron J. Tande ◽  
Benjamin D. Pollock ◽  
Matthew R. Neville ◽  
Henry H. Ting ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Adult Patients ◽  
Care Hospital ◽  
Strict Adherence ◽  
Large Tertiary Care ◽  
Healthcare Associated ◽  
Serology Testing ◽  
Pcr Test

Abstract Objective: We evaluated the risk of patients contracting coronavirus disease 2019 (COVID-19) during their hospital stay to inform the safety of hospitalization for a non–COVID-19 indication during this pandemic. Methods: A case series of adult patients hospitalized for 2 or more nights from May 15 to June 15, 2020 at large tertiary-care hospital in the midwestern United States was reviewed. All patients were screened at admission with the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test. Selected adult patients were also tested by IgG serology. After dismissal, patients with negative serology and PCR at admission were asked to undergo repeat serologic testing at 14–21 days after discharge. The primary outcome was healthcare-associated COVID-19 defined as a new positive SARS-CoV-2 PCR test on or after day 4 of hospital stay or within 7 days of hospital dismissal, or seroconversion in patients previously established as seronegative. Results: Of the 2,068 eligible adult patients, 1,778 (86.0%) completed admission PCR testing, while 1,339 (64.7%) also completed admission serology testing. Of the 1,310 (97.8%) who were both PCR and seronegative, 445 (34.0%) repeated postdischarge serology testing. No healthcare-associated COVID-19 cases were detected during the study period. Of 1,310 eligible PCR and seronegative adults, no patients tested PCR positive during hospital admission (95% confidence interval [CI], 0.0%–0.3%). Of the 445 (34.0%) who completed postdischarge serology testing, no patients seroconverted (0.0%; 95% CI, 0.0%–0.9%). Conclusion: We found low likelihood of hospital-associated COVID-19 with strict adherence to universal masking, physical distancing, and hand hygiene along with limited visitors and screening of admissions with PCR.

scholarly journals 124. Six-year Longitudinal Analysis of an Inpatient Infectious Diseases Telemedicine Service at a Community Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S191-S192
Author(s):  
Nupur Gupta ◽  
Adit B Sanghvi ◽  
John Mellors ◽  
Rima Abdel-Massih
Keyword(s):  
Infectious Disease ◽  
Tertiary Care ◽  
Medical Officer ◽  
Rural Hospital ◽  
Hospital Length Of Stay ◽  
Observation Study ◽  
Patient Acuity ◽  
Telemedicine Service ◽  
Tertiary Care Centers ◽  
Over Time

Abstract Background Telemedicine (TM) has emerged as a viable solution to extend infectious disease (ID) expertise to communities without access to this specialty.1 TM allows clinicians in rural settings to connect with specialists at distant sites and provide the best care for their patients, often eliminating the need for hospital transfers. Here, we describe the experience from one of the longest standing inpatient Tele-ID consult services using live audio-video (AV) visits with the assistance of a telepresenter. Methods Longitudinal data were collected from a 126-bed rural hospital in Pennsylvania that had no access to ID consultation before 2014. Live AV consults during business hours began in 2014 and telephonic physician to physician consults were made available 24/7. All ID consult data were extracted from the hospital electronic health record between 2014 to 2019. Key outcomes assessed included the number of consult encounters, total hospital length of stay (LOS), discharges to home, transfer to tertiary care centers, and readmission rates at 30 days. Results Most consulted patients were Caucasians, and females with an average age of 64.7 years (Table 1). The number of unique consult encounters increased annually from 111 in 2014 to 469 in 2019 (Table 1). The Charlson Comorbidity Score and Elixhauser Comorbidity Index also increased each year beginning in 2016 (Table 1). By contrast, LOS decreased each year as did the 30-day readmission rate (Table 2). Most patients were not transferred (average 89.4% over 6 years) to tertiary care centers and more than half were discharged to home each year (Table 2). Conclusion This longitudinal 6-year observation study of an inpatient TM ID service at a rural hospital showed remarkable annual growth in consult encounters (total growth &gt;400%). Despite increasing patient acuity, overall hospital LOS decreased over time (10.2 to 8.2 days). Patient transfers to tertiary care centers remained low (average 10.5% over 6 years) as did 30-day readmissions (average 16.3% over 6 years). The majority of patients were discharged to home (average 61.3% over 6 years). These findings show that a rural inpatient TM ID consult service can expand over time and is an effective alternative for hospitals without access to ID expertise. Disclosures John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer)

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