scholarly journals Characteristics of Academic Medical Centers Associated with Ischemic Stroke Outcome

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 382-382
Author(s):  
S. Claiborne Johnston ◽  
Leslie A Gillum
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Academic Medical Centers ◽  
Administrative Database ◽  
Hospital Death ◽  
Improvement Project ◽  
Medical Centers ◽  
Academic Medical ◽  
Hospital Deaths

P235 Background: Data supporting the efficacy of stroke center characteristics are limited. Methods: A questionnaire detailing stroke treatment practices was sent to 42 academic medical centers in the University Health Systems Consortium participating in a quality improvement project. In-hospital mortality of all emergency-department admissions for ischemic stroke at these institutions was evaluated in a large administrative database from 1997 through 1999. We used a multivariable method called generalized estimating equations, which broadens confidence intervals to adjust for clustering of variables at institutions. Using this technique, institutional characteristics were evaluated as predictors of in-hospital mortality after adjusting for age, gender, race, hospital treatment volume of ischemic stroke, and admission status (emergent, urgent, elective). Results: Thirty-two institutions completed the questionnaire and 29 of these were included in the administrative database. In-hospital deaths occurred in 758 (7.0%) of the 10,880 ischemic strokes admitted through the emergency department. In-hospital deaths were less frequent at hospitals with a vascular neurologist (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.36–0.74, p<0.001), and at those with guidelines stating that only neurologists could administer tPA (OR 0.65, 95% CI 0.49–0.88, p=0.004). There was a trend toward fewer deaths at hospitals with a dedicated stroke team available by pager (OR 0.76, 95% CI 0.56–1.04, p=0.09). The presence of a dedicated neurological intensive care unit, stroke unit, and written clinical pathway for stroke were not significantly associated with in-hospital death. Conclusions: Academic medical centers with a vascular neurologist and those with written guidelines limiting tPA administration to neurologists had lower rates of in-hospital mortality for ischemic stroke patients.

scholarly journals Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Stroke ◽  
2001 ◽  
Vol 32 (9) ◽  
pp. 2137-2142 ◽  
Author(s):  
Leslie Allison Gillum ◽  
S. Claiborne Johnston
Keyword(s):  
Ischemic Stroke ◽  
Academic Medical Centers ◽  
Stroke Outcomes ◽  
Medical Centers ◽  
Academic Medical

Increasing Utilization of Laparoscopic Gastric Banding in the Adolescent: Data from Academic Medical Centers, 2002-2009

2011 ◽  
Vol 77 (11) ◽  
pp. 1510-1514 ◽  
Author(s):  
Ninh T. Nguyen ◽  
Farah Karipineni ◽  
Hossein Masoomi ◽  
Kelly Laugenour ◽  
Kevin Reavis ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Hospital Mortality ◽  
Gastric Banding ◽  
Laparoscopic Gastric Banding ◽  
Academic Medical Centers ◽  
Perioperative Outcomes ◽  
Patients Âgés ◽  
Medical Centers ◽  
Academic Medical ◽  
Adolescent Bariatric Surgery

Bariatric surgery in the adolescent continues to be a controversial topic. This study compared the utilization and perioperative outcomes of adolescent bariatric surgery performed at academic centers from 2002 to 2006 versus 2007 to 2009. We obtained data from the University HealthSystem Consortium for all adolescent patients (ages 12-18 years) who underwent bariatric surgery for the treatment of morbid obesity between 2002 and 2009. Outcomes including type of procedure, characteristics, length of stay, 30-day readmission, morbidity, and in-hospital mortality were compared between the two time periods. From 2007 to 2009, 340 adolescents underwent bariatric surgery at 63 academic hospitals. The mean number of adolescent bariatric procedures performed/year increased from 61.8 in 2002 to 2006 to 113.3 procedures/year in 2007 to 2009. There was an increase in utilization of laparoscopic gastric banding from 29 per cent to 50 per cent with a decrease in utilization of gastric bypass from 62 per cent to 48 per cent, respectively. For 2007 to 2009, the overall morbidity was 2.9 per cent with a 30-day readmission of 1.5 per cent and an in-hospital mortality of 0 per cent. Within the context of academic medical centers, adolescent bariatric surgery is associated with low morbidity and no mortality. Compared with 2002 to 2006, there has been an increase in the number of adolescent bariatric operations with increase in utilization of the laparoscopic gastric banding.

scholarly journals 1178. Risk factors for death among patients with Candida endocarditis: An observational study in US academic medical centers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S614-S614
Author(s):  
Jonathan Huggins ◽  
Michael Z David ◽  
Samuel F Hohmann
Keyword(s):  
Risk Factors ◽  
Liver Failure ◽  
Case Series ◽  
Academic Medical Centers ◽  
Hospital Death ◽  
Hepatitis C Infection ◽  
Risk Of Death ◽  
Medical Centers ◽  
Opiate Abuse ◽  
Academic Medical

Abstract Background Candida endocarditis is a rare, sometimes fatal complication candidemia. Our understanding of this condition is limited to findings from case series and small observational studies. Using the Vizient clinical database, a repository for clinical and administrative data from 117 academic medical centers and more than 300 affiliated hospitals, we assembled the largest cohort of Candida endocarditis patients to date, reporting patient characteristics and risk factors for death. Methods Using ICD-10 code B37.6 (Candidal Endocarditis) we identified 703 inpatients at 179 United States hospitals from October 2015 through April 2019. We examined demographic, diagnostic, and procedural data from each patient’s initial encounter. With univariate and multivariate logistic regression analyses we identified predictors of in-hospital mortality. Results Of 703 patients, 402 (57.2%) were male, 421 (59.9%) used tobacco, 213 (30.3%) had documented opiate abuse, 128 (18.2%) had other illicit drug abuse documented, and 190 (27.0%) had documented hepatitis C infection. Among the 703 patients, 114 (16.2%) died during the index encounter. On multivariate analysis, liver failure was the strongest predictor of death (OR 8.4, 95% CI 4.4 – 15.9), and female sex (OR 1.8, 95% CI 1.1 – 2.9), transfer from an outside facility (OR 1.7, 95% CI 1.1 – 2.7), underlying aortic valve pathology (OR 2.8, 95% CI 1.5 – 4.9), hemodialysis (OR 2.0, 95% CI 1.0 – 3.8), cerebrovascular disease (OR 2.2, 95% CI 1.2 – 3.8), neutropenia (OR 2.5, 95% CI 1.3 – 4.7) and alcohol abuse (OR 2.9, 95% CI 1.3 – 6.7) were also associated with higher odds of in-hospital death. In the same analysis, opiate abuse was associated with a lower odds of in-hospital death (OR 0.4, 95% CI 0.2 – 0.8). Table 1. Characteristics of 703 patients with Candida endocarditis Table 2. Factors associated with in-hospital death in multivariate regression analysis Conclusion We found that for patients Candida endocarditis inpatient mortality was 16.2% and liver failure was associated with a high risk of death while opiate abuse was protective. Further investigation is necessary to better understand these associations. Disclosures Michael Z. David, MD PhD, GSK (Consultant)

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