Sex, Race, Insurance, and Pain: Do Patient Sociodemographics Influence Postoperative Opioid Prescriptions Among Hand Surgeons?

Hand ◽  
2021 ◽  
pp. 155894472199802
Author(s):  
Connor J. Peck ◽  
Martin Carney ◽  
Alexander Chiu ◽  
Kitae E. Park ◽  
Alexandre Prassinos ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Medical Center ◽  
Carpal Tunnel Release ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Age Groups ◽  
Postoperative Pain Management ◽  
Patient Treatment ◽  
Opioid Prescription ◽  
History Of

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups. Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

scholarly journals High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

2020 ◽  
Author(s):  
Yang Tao ◽  
Panke Cheng ◽  
Wen Chen ◽  
Peng Wan ◽  
Yaokai Chen ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Medical Center ◽  
Age Groups ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Asymptomatic Patients ◽  
Imported Cases ◽  
History Of ◽  
Epidemiological Characteristics

SummaryBackgroundSARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection.MethodsIn this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed.Findings82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days).ConclusionThe SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

Millennials Seeking Healthcare: Examining the Degree to Which Patients Utilize Online Resources (Preprint)

2021 ◽  
Author(s):  
Landon Arensberg ◽  
Jessica Kalender-Rich ◽  
Jaehoon Lee ◽  
Cheryl Gibson
Keyword(s):  
Medical Care ◽  
Baby Boomers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Age Groups ◽  
Online Reviews ◽  
Online Resources ◽  
Cross Sectional ◽  
Academic Medical ◽  
Us Census

BACKGROUND According to the 2020 US Census, a Silver Tsunami is looming with more than 75.4 million persons aged 57-75 (known as “Baby Boomers”) expected to need more costly medical care. Future estimates, however, indicate a much larger wave of individuals is imminent, given the 83.1 million Millennials approaching adulthood who will be seeking medical care. Because Millennials differ from Baby Boomers in several ways, it is important to understand how this population finds their physician to gain insight into what might influence this decision. OBJECTIVE To determine the extent and influence online resources and reviews have on the younger generation as compared to elder generations. METHODS Between the months of May and July 2020 a cross-sectional paper-based survey was conducted at primary care and geriatric clinics located within a large urban academic medical center in the Midwest. RESULTS A sample of 284 patients completed the survey (44.35 ± 17.54 yrs old [range=18-90], 60.6% female, 57.4% white). Of Millennials (respondents aged 22-38 yrs), 67.2% read online reviews before choosing a physician. Millennials were significantly more likely to read online reviews before choosing a physician (P=0.004) and utilize online resources to search for a new physician (P<.001) than older patients. The majority of millennials were likely to be influenced by both negative reviews (59%) and positive reviews (71.3%). Female patients were more likely to read online reviews and use online resources compared to men, but the differences were not significant. CONCLUSIONS Overall, Millennials are much more likely to research online reviews before choosing a physician. Other generations also use online resources to an extent but tend to use personal referrals. Across all age groups, negative online reviews were less influential in decision-making compared to positive ones. Therefore, a presence on review websites and search engines seems to only benefit one’s medical practice to capture the new wave of patients.

scholarly journals History of Depression and Increased Risk of Sternal Wound Infection After Cardiothoracic Surgery: A Novel and Potentially Modifiable Risk Factor

2019 ◽  
Vol 6 (3) ◽  
Author(s):  
Deborah A Theodore ◽  
Renee D Goodwin ◽  
Yuan (Vivian) Zhang ◽  
Nancy Schneider ◽  
Rachel J Gordon
Keyword(s):  
Risk Factors ◽  
Wound Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cardiothoracic Surgery ◽  
Sternal Wound Infection ◽  
Composite Variable ◽  
Increased Risk ◽  
History Of ◽  
History Of Depression

Abstract Background Sternal wound infection (SWI) is a leading cause of postoperative disease and death; the risk factors for SWI remain incompletely understood. The goal of the current study was to investigate the relationship between a preoperative history of depression and the risk of SWI after cardiothoracic surgery. Methods Among patients undergoing cardiothoracic surgery in a major academic medical center between 2007 and 2012, those in whom SWI developed (n = 129) were matched, by date of surgery, with those in whom it did not (n = 258). Multivariable logistic regression was used to examine the strength of relationships between risk factors and development of infection. History of depression was defined as a composite variable to increase the sensitivity of detection. Results History of depression as defined by our composite variable was associated with increased risk of SWI (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–4.7; P = .01). Staphylococcus aureus was the most common organism isolated. Conclusions History of depression was associated with increased risk of SWI. Future prospective studies are warranted to further investigate this relationship. Depression is highly treatable, and increased efforts to identify and treat depression preoperatively may be a critical step toward preventing infection-related disease and death.

Tolerability of a probiotic in subjects with a history of methicillin-resistant Staphylococcus aureus colonisation

2014 ◽  
Vol 5 (4) ◽  
pp. 389-395 ◽  
Author(s):  
S. Warrack ◽  
P. Panjikar ◽  
M. Duster ◽  
N. Safdar
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Controlled Trial ◽  
Academic Medical Center ◽  
Resistant Bacteria ◽  
Public Health Importance ◽  
Methicillin Resistant ◽  
History Of ◽  
Study Population

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of major public health importance. Colonisation precedes infection; thus reducing MRSA carriage may be of benefit for reducing infection. Probiotics represent a novel approach to reducing MRSA carriage. We undertook a pilot feasibility randomised controlled trial of the tolerability and acceptability of probiotics for reducing nasal and intestinal carriage of MRSA. In addition, subjects were screened for vancomycin-resistant enterocococci (VRE). Subjects with a history of MRSA were recruited from a large, academic medical center and randomised to take either a placebo or probiotic (Lactobacillus rhamnosus HN001). Subjects returned to the clinic after four weeks for further testing to determine adherence to the probiotic regimen and colonisation of MRSA. 48 subjects were enrolled and randomised. Nearly 25% were transplant recipients and 30% had diabetes. The probiotic was well tolerated in the study population though minor side effects, such as nausea and bloating, were observed. A majority of the subjects randomised to HN001 had good adherence to the regimen. At the four week time point among subjects randomised to the probiotic, MRSA was detected in 67 and 50% of subjects colonised in the nares and the gastrointestinal tract, respectively. Three subjects who initially tested positive for VRE were negative after four weeks of probiotic exposure. Probiotics were well tolerated in our study population of largely immunocompromised subjects with multiple comorbidities. Adherence to the intervention was good. Probiotics should be studied further for their potential to reduce colonisation by multidrug resistant bacteria.

Quantification of the impact of multifaceted improvements in patient safety culture: A case study from academic medical center radiation oncology department.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 205-205
Author(s):  
Bhishamjit S. Chera ◽  
Lukasz Maszur ◽  
Prithima Mosaly ◽  
Marianne Jackson ◽  
Kinely Taylor ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Peer Review Process ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Safety Culture ◽  
Process Engineering ◽  
Patient Treatment ◽  
Task Load ◽  
Number Of Patients ◽  
The Impact

205 Background: We have systematically been incorporating several safety initiatives (based on process-engineering and Lean methodologies) into our academic radiation oncology clinic. We herein quantify the impact of these initiatives on prospectively collected, clinically meaningful metrics. Methods: The data from five quality improvement initiatives are presented. For each, data was collected prospectively: operational metrics recorded before and after implementation of the initiative were compared using descriptive statistics and unpaired student t-test. Each initiative focused on a specific safety/process concern in our clinic. Results: 1) Workload levels for nurses assisting with brachytherapy were too high (NASA task load index scores >55-60, suggesting, “overwork”). Changes in work flow and procedure room layout reduced workload scores to more acceptable limits (<55). 2) The rate of treatment therapists being interrupted was reduced from a mean of 4 (range 1-11) times per patient treatment to a mean < 1 (range 0-3, p<0.001) after implementing standards for electronic communication and placement of monitors informing patients and staff of the treatment machine status (e.g., delayed, on time). 3) The rates of replans by dosimetrists was reduced from 11% in 2010 to 6% in 2011 though a more systematic pre-treatment peer review process. 4) Standardizing nursing/resident functions reduced patient wait times by ≈ 45% (14 min). 5) Standardizing pre-simulation instructions from the physician within the EMR reduced the number of patients experiencing delays on the simulator (from approximatley >50% to <10%). Conclusions: Process engineering and Lean methodologies can be successfully applied in an academic radiation oncology department to yield measurable improvements in operations likely improving quality/safety.

Factors Related to Complications Among Adult Patients With Intellectual Disabilities Hospitalized at an Academic Medical Center

2015 ◽  
Vol 53 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Sarah H. Ailey ◽  
Tricia J. Johnson ◽  
Louis Fogg ◽  
Tanya R. Friese
Keyword(s):  
Intellectual Disabilities ◽  
Medical Center ◽  
Academic Medical Center ◽  
Autism Spectrum ◽  
Adult Patients ◽  
Respiratory Disorder ◽  
Academic Medical ◽  
History Of ◽  
Healthcare Acquired Infections ◽  
Improve Hospital

Abstract People with intellectual disabilities (ID) represent a small but important group of hospitalized patients who have higher rates of complications than do patients without ID hospitalized for the same reasons. Complications are potentially avoidable conditions, such as healthcare-acquired infections, healthcare-acquired skin breakdown, falls, and medication errors and reactions. Addressing factors related to complications can focus efforts to improve hospital care. The purpose of this exploratory study was to analyze data from reviews of academic medical center charts (N  =  70) about complications and to examine patient and hospitalization characteristics in relation to complications among adult patients (age ≥ 18 years) with ID hospitalized for nonpsychiatric reasons. Adults with ID tended to be twice as likely to have complications (χ2  =  2.893, df  =  1, p  =  .09) if they had a surgical procedure and were nearly four times as likely to have complications (χ2  =  6.836, df  =  1, p  =  .009) if they had multiple chronic health conditions (three of the following: history of cerebral palsy, autism spectrum symptoms, aggressive behavior, respiratory disorder, and admission through the emergency department). Findings suggest preliminary criteria for assessing risk for complications among hospitalized people with ID and the need for attention to their specific needs when hospitalized.

scholarly journals Independent risk factors for chronic illicit substance use during pregnancy

2020 ◽  
Vol 16 (5) ◽  
pp. 351-356
Author(s):  
Manuel C. Vallejo, MD, DMD ◽  
Robert E. Shapiro, MD ◽  
Mitchell W. Lippy, BS ◽  
Christa L. Lilly, PhD ◽  
Leo R. Brancazio, MD
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Medical Center ◽  
Academic Medical Center ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Academic Medical ◽  
Multiple Variable ◽  
History Of ◽  
Independent Risk Factors

Objective: We aimed to determine the incidence of chronic illicit substance use during pregnancy and to identify associated risk factors.Design: A 2-year time-matched retrospective maternal quality control database (n = 4,470) analysis of parturients with chronic illicit substance use compared to controls.Setting: A tertiary academic medical center located in a rural setting.Results: The rate of chronic illicit substance use was 1.95 percent. Demographic factors associated with chronic illicit substance use in pregnancy-included lower body mass index (BMI; OR: 0.93; 95 percent CI: 0.89-0.96, p 0.0001), higher gravidity (OR: 1.24; 95 percent CI: 1.13-1.36, p 0.0001), higher parity (OR: 1.38; 95 percent CI: 1.22-1.57, p 0.0001), and more live births (OR: 1.30; 95 percent CI: 1.16-1.46, p 0.0001). A history of smoking (OR: 10.51; 95 percent CI: 5.69-19.42, p 0.0001), alcohol use (OR: 48.98; 95 percent CI: 17.33-138.40, p 0.0001), anxiety (OR: 1.88; 95 percent CI: 1.16-3.05, p = 0.01), depression (OR: 2.44; 95 percent CI: 1.55-3.85, p = 0.0001), transfer on admission (OR: 2.12; 95 percent CI: 1.16-3.87, p = 0.01), payor insurance (OR: 2.12, 95 percent CI: 2.10-5.04, p 0.0001), and Apgar scores 7 at 1 minute (OR: 0.50; 95 percent CI: 0.25-1.00, p = 0.049) were significant. Multiple variable logistic regression-revealed BMI, smoking, alcohol use, and Apgar score 7 at 1 minute as significant factors.Conclusions: Awareness of these factors can assist in identifying and treating parturients with chronic illicit substance use.

scholarly journals Evaluation of Thrombotic Risk in Thyroid Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A861-A861
Author(s):  
Chukwuka Akamnonu ◽  
David A Cohen
Keyword(s):  
Pulmonary Embolism ◽  
Thyroid Cancer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Cancer History ◽  
Thrombotic Risk ◽  
History Of

Abstract Introduction: Current guidelines from the International Society of Thrombosis and Hemostasis recommend limited screenings for deep vein thrombosis (DVT) or pulmonary embolism (PE) with no identifiable precipitating factor (termed unprovoked). There is paucity of data with regards to thyroid cancer screening in the setting of an unprovoked VTE. Studies from Europe have shown an association between VTE and thyroid cancer; however, these studies do not account for differences in iodine availability, thus the need for studies in the United States. Understanding the risk of thyroid cancer as a provocative factor in developing a deep venous thrombosis (DVT) or pulmonary embolism (PE) may be able to facilitate case detection of disease and prevent future morbidity and mortality from thyroid cancer and/or VTE. Objectives: The primary objective of this study is to understand the risk of developing VTE in the setting of thyroid cancer. Methods: In this retrospective chart review study, we reviewed electronic medical records of patients with a history of DVT or PE between ages 18-99, presenting to all outpatient clinics at a single academic medical center in New Jersey between October 1, 2015, and Dec 31, 2018. We screened for coexistent cancer history among this group, and from this sample we further isolated cases of thyroid cancer. Results: 345 patients were found to have a history of VTE. 187 were female (54%) and 113 (29%) had a history of malignancy. The most common cancers were breast (19%), colorectal (9%), leukemia (9%), prostate (8%), and lymphoma (8%). Thyroid cancer accounted for 2% of all discovered cases. Conclusion: In this retrospective analysis, 2% of all patients with VTE and cancer carried a diagnosis of thyroid cancer. Although this suggests a relatively low risk, given the medical burden of a venous thromboembolism and the comparable proportion of thyroid cancer in all new cancer cases, thyroid cancer should be considered a provoking factor in unprovoked VTE.

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