scholarly journals Trauma care during the COVID-19 pandemic in the Netherlands: a level 1 trauma multicenter cohort study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Nadia A. G. Hakkenbrak ◽  
Sverre A. I. Loggers ◽  
Eva Lubbers ◽  
Jarik de Geus ◽  
Stefan F. van Wonderen ◽  
...  
Keyword(s):  
Health Care ◽  
Trauma Care ◽  
Burden Of Disease ◽  
Injury Severity ◽  
Medical Center ◽  
Academic Medical Center ◽  
Trauma Patients ◽  
Health Care Planning ◽  
Health Care Consumption ◽  
Multicenter Cohort Study

Abstract Purpose The coronavirus (COVID-19) pandemic has caused major healthcare challenges worldwide resulting in an exponential increase in the need for hospital- and intensive care support for COVID-19 patients. As a result, surgical care was restricted to urgent cases of surgery. However, the care for trauma patients is not suitable for reduction or delayed treatment. The influence of the pandemic on the burden of disease of trauma care remains to be elucidated. Methods All patients with traumatic injuries that were presented to the emergency departments (ED) of the Amsterdam University Medical Center, Location Academic Medical Center (AMC) and VU medical center (VUMC) and the Northwest Clinics (NWC) between March 10, 2019 and May 10, 2019 (non-COVID) and March 10, 2020 and May 10, 2020 (COVID-19 period) were included. The primary outcome was the difference in ED admissions for trauma patients between the non-COVID and COVID-19 study period. Additionally, patient- and injury characteristics, health care consumption, and 30-day mortality were evaluated. Results A 37% reduction of ED admissions for trauma patients was seen during the COVID-19 pandemic (non-COVID n = 2423 and COVID cohort n = 1531). Hospital admission was reduced by 1.6 trauma patients per day. Fewer patients sustained car- and sports-related injuries. Injuries after high energetic trauma were more severe in the COVID-19 period (Injury Severity Score 17.3 vs. 12.0, p = 0.006). Relatively more patients were treated operatively (21.4% vs. 16.6%, p < 0.001) during the COVID-19 period. Upper-(17.6 vs. 12.5%, p = 0.002) and lower extremity injuries (30.7 vs. 23.0%, p = 0.002) mainly accounted for this difference. The 30-day mortality rate was higher during the pandemic (1.0 vs. 2.3%, p = 0.001). Conclusion The burden of disease and healthcare consumption of trauma patients remained high during the COVID-19 pandemic. Results of this study can be used to optimize the use of hospital capacity and anticipate health care planning in future outbreaks.

scholarly journals 460. Point-of-Care, In-Home SARS-CoV-2 IgG Antibody Testing to Assess Seroprevalence in At-Risk Health Care Workers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S297-S297
Author(s):  
Eric G Meissner ◽  
Christine Litwin ◽  
Tricia Crocker ◽  
Elizabeth Mack ◽  
Lauren Card
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Workers ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Documented Infection ◽  
Inconclusive Result ◽  
Care Workers

Abstract Background Health care workers are at significant risk for infection with the novel coronavirus SARS-CoV-2. Methods We utilized a point-of-care, lateral flow SARS-CoV-2 IgG immunoassay (RayBiotech) to conduct a seroprevalence study in a cohort of at-risk health care workers (n=339) and normal-risk controls (n=100) employed at an academic medical center. To minimize exposure risk while conducting the study, consents were performed electronically, tests were mailed and then self-administered at home using finger stick blood, and subjects uploaded a picture of the test result while answering an electronic questionnaire. We also validated the assay using de-identified serum samples from patients with PCR-proven SARS-CoV-2 infection. Results Between April 14th and May 6th 2020, 439 subjects were enrolled. Subjects were 68% female, 93% white, and most were physicians (38%) and nurses (27%). In addition, 37% had at least 1 respiratory symptom in the prior month, 34% had cared for a patient with known SARS-CoV-2 infection, 57% and 23% were worried about exposure at work or in the community, respectively, and 5 reported prior documented SARS-CoV-2 infection. On initial testing, 3 subjects had a positive IgG test, 336 had a negative test, and 87 had an inconclusive result. Of those with an inconclusive result who conducted a repeat test (85%), 96% had a negative result. All 3 positive IgG tests were in subjects reporting prior documented infection. Laboratory validation showed that of those with PCR-proven infection more than 13 days prior, 23/30 were IgG positive (76% sensitivity), whereas 1/26 with a negative prior PCR test were seropositive (95% specificity). Repeat longitudinal serologic testing every 30 days for up to 4 times is currently in progress. Conclusion We conducted a contact-free study in the setting of a pandemic to assess SARS-CoV-2 seroprevalence in an at-risk group of health care workers. The only subjects found to be IgG positive were those with prior documented infection, even though a substantial proportion of subjects reported significant potential occupational or community exposure and symptoms that were potentially compatible with SARS-COV-2 infection. Disclosures All Authors: No reported disclosures

scholarly journals Utility of Natural Language Processing for Clinical Quality Measures Reporting

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Dino P. Rumoro ◽  
Shital C. Shah ◽  
Gillian S. Gibbs ◽  
Marilyn M. Hallock ◽  
Gordon M. Trenholme ◽  
...  
Keyword(s):  
Health Care ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Quality Measures ◽  
Surveillance Program ◽  
Free Text ◽  
Influenza Immunization

ObjectiveTo explain the utility of using an automated syndromic surveillanceprogram with advanced natural language processing (NLP) to improveclinical quality measures reporting for influenza immunization.IntroductionClinical quality measures (CQMs) are tools that help measure andtrack the quality of health care services. Measuring and reportingCQMs helps to ensure that our health care system is deliveringeffective, safe, efficient, patient-centered, equitable, and timely care.The CQM for influenza immunization measures the percentage ofpatients aged 6 months and older seen for a visit between October1 and March 31 who received (or reports previous receipt of) aninfluenza immunization. Centers for Disease Control and Preventionrecommends that everyone 6 months of age and older receive aninfluenza immunization every season, which can reduce influenza-related morbidity and mortality and hospitalizations.MethodsPatients at a large academic medical center who had a visit toan affiliated outpatient clinic during June 1 - 8, 2016 were initiallyidentified using their electronic medical record (EMR). The 2,543patients who were selected did not have documentation of influenzaimmunization in a discrete field of the EMR. All free text notes forthese patients between August 1, 2015 and March 31, 2016 wereretrieved and analyzed using the sophisticated NLP built withinGeographic Utilization of Artificial Intelligence in Real-Timefor Disease Identification and Alert Notification (GUARDIAN)– a syndromic surveillance program – to identify any mention ofinfluenza immunization. The goal was to identify additional cases thatmet the CQM measure for influenza immunization and to distinguishdocumented exceptions. The patients with influenza immunizationmentioned were further categorized by GUARDIAN NLP intoReceived, Recommended, Refused, Allergic, and Unavailable.If more than one category was applicable for a patient, they wereindependently counted in their respective categories. A descriptiveanalysis was conducted, along with manual review of a sample ofcases per each category.ResultsFor the 2,543 patients who did not have influenza immunizationdocumentation in a discrete field of the EMR, a total of 78,642 freetext notes were processed using GUARDIAN. Four hundred fiftythree (17.8%) patients had some mention of influenza immunizationwithin the notes, which could potentially be utilized to meet the CQMinfluenza immunization requirement. Twenty two percent (n=101)of patients mentioned already having received the immunizationwhile 34.7% (n=157) patients refused it during the study time frame.There were 27 patients with the mention of influenza immunization,who could not be differentiated into a specific category. The numberof patients placed into a single category of influenza immunizationwas 351 (77.5%), while 75 (16.6%) were classified into more thanone category. See Table 1.ConclusionsUsing GUARDIAN’s NLP can identify additional patients whomay meet the CQM measure for influenza immunization or whomay be exempt. This tool can be used to improve CQM reportingand improve overall influenza immunization coverage by using it toalert providers. Next steps involve further refinement of influenzaimmunization categories, automating the process of using the NLPto identify and report additional cases, as well as using the NLP forother CQMs.Table 1. Categorization of influenza immunization documentation within freetext notes of 453 patients using NLP

Addressing the mental health needs of learners and nonlearners in an academic medical center during COVID-19

2021 ◽  
pp. 1-15
Author(s):  
Zina V. Peters ◽  
Lynn N. Norwood ◽  
Hetal P. Modi ◽  
Heather Goodman ◽  
Peggy H. Yang ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Well Being ◽  
Behavioral Health Care ◽  
Psychological Needs ◽  
Individual Therapy ◽  
Biomedical Sciences ◽  
Therapy Services

The Coronavirus Disease (COVID-19) has impacted life for people throughout the world, especially for those in health care who experience unique stressors. To support the psychological needs of staff, faculty, and learners at a biomedical sciences university, faculty at Baylor College of Medicine created a mental health and wellness support program consisting of multiple behavioral health care pathways, including phone support, a self-guided mental health app, a coping skills group, and individual therapy services. The authors present this program as a model for academic institutions to support the well-being of faculty, staff, and learners.

scholarly journals Health Care Expenditures for University and Academic Medical Center Employees Enrolled in a Pilot Workplace Health Partner Intervention

2015 ◽  
Vol 57 (8) ◽  
pp. 897-903 ◽  
Author(s):  
Kenton J. Johnston ◽  
Jason M. Hockenberry ◽  
Kimberly J. Rask ◽  
Lynn Cunningham ◽  
Kenneth L. Brigham ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Health Care Expenditures ◽  
Workplace Health ◽  
Academic Medical

scholarly journals Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center

2019 ◽  
Vol 8 ◽  
pp. 216495611983748 ◽  
Author(s):  
Susanne M Cutshall ◽  
Tejinder K Khalsa ◽  
Tony Y Chon ◽  
Sairey M Vitek ◽  
Stephanie D Clark ◽  
...  
Keyword(s):  
Health Care ◽  
Integrative Medicine ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Curricular Development ◽  
Medical Needs ◽  
Academic Medical ◽  
Number Of Patients ◽  
Prevention And Health Promotion

A growing number of patients and consumers are seeking integrative medicine (IM) approaches as a result of increasing complex medical needs and a greater emphasis on prevention and health promotion. Health-care professionals need to have knowledge of the evidence-based IM resources that are safe and available to patients. Medical institutions have acknowledged the need for education and training in various IM modalities and whole-health approaches in medical curricula. There is a strong need to develop and incorporate well-structured IM curricula across all levels of learning and practice within medicine. This article provides an example of the development, implementation, impact, and assessment of IM education curricula across all learner levels at a large academic medical center.

scholarly journals Health and healthcare in the year 2040 – Facts for planning a complex and uncertain future

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
T Funk ◽  
B Forsberg
Keyword(s):  
Health Care ◽  
Burden Of Disease ◽  
Health Care Services ◽  
Disease Burden ◽  
Health Planning ◽  
Health Care Planning ◽  
Care Needs ◽  
Future Health ◽  
Care Services ◽  
Future Health Care

Abstract Background In the Stockholm region, a regional political assembly is responsible for health care services for a population of 2.3 million. In November 2017, the political leadership decided on a programme to project health and healthcare developments in the Stockholm region until 2040 as a basis for a longterm health plan. This presentation aims to describe the methodology used, share some results and raise some questions for further work. Through the presentation we also seek collaboration with European partners involved in similar health planning work. Methodology Six perspectives for analysis were defined and under each a set of areas for deeper analysis identified. It was agreed that the planning should be fact-driven. Under the constraint of availability, data covering the period 2000 to 2017 was collected for around 90 variables. Data was gathered from various publicly available databases and was analysed in Microsoft Excel. Results Stockholm’s population increased continuously since the millennial shift and could increase by another 28% until 2040. Since 2000, life expectancy increased by 2 years for women and 3 years for men. More than 85% of the burden of disease is caused by chronic diseases. However, the overall disease burden per 100 000 population has been decreasing over the years. In 2017, more than 21 million outpatient care visits were done. Extrapolations of these trends show that the disease burden per capita will continue to decrease, but the total burden of disease as well as demand for health care will continue to increase. Discussion A fact-based analysis of future health and healthcare proved to be an efficient base for planning and discussions of future health care services. Results confirmed some well-established perceptions of developments but also pointed to some misconceptions and established “facts” that proved to be false. New digital services make prediction of the future health service mix dynamic and challenging. Key messages To meet future health care needs, future health and health care trends should be planned for and considered in decision making processes. Forecasts and health care planning should be fact-based to have an as accurate picture of future health and health care trends as possible.

scholarly journals The Experience of Providing Physical Therapy in a Changing Health Care Environment

2002 ◽  
Vol 82 (7) ◽  
pp. 648-657 ◽  
Author(s):  
Rosemary Blau ◽  
Sarah Bolus ◽  
Terrence Carolan ◽  
Daniel Kramer ◽  
Elizabeth Mahoney ◽  
...  
Keyword(s):  
Health Care ◽  
Work Environment ◽  
Health Care Professionals ◽  
Phenomenological Study ◽  
Physical Therapists ◽  
Medical Center ◽  
Systemic Change ◽  
Academic Medical Center ◽  
Health Care Environment ◽  
Care Environment

Abstract Background and Purpose. The changes in the health care environment during the last decade have had an impact on the roles and responsibilities of all health care professionals. The purpose of this phenomenological study was to describe the experience of staff physical therapists during a time of systemic change within a large urban academic medical center. Subjects and Methods. Participants were 5 physical therapists working in various clinical settings within the medical center. The participants were interviewed and asked the question “Over the past 4 years, there have been major changes in your work environment. What has it been like for you working as a clinician during this time of change?” Interviews were recorded, transcribed, and analyzed to find thematic patterns of responses. Results. Four common themes emerged in which participants described experiencing loss of control, stress, discontent, and disheartenment. A fifth theme showed that despite these negative feelings, participants were able to “find the silver lining” in their daily work lives (ie, they were able to find positive aspects of their professional lives despite the perceived unpleasant changes with which they had to cope). Discussion and Conclusion. This study provides insight into the experiences of a group of staff physical therapists during a time of systemic change in their work environment. Although the themes reflect largely unsettling and negative experiences, there seems to be an underlying ability to find affirmative aspects of work.

Recurrent Acute Rhinosinusitis

2011 ◽  
Vol 146 (2) ◽  
pp. 307-312 ◽  
Author(s):  
Neil Bhattacharyya ◽  
Jeff Grebner ◽  
Noel G. Martinson
Keyword(s):  
Computed Tomography ◽  
Health Care ◽  
Health Care Costs ◽  
Medical Center ◽  
Academic Medical Center ◽  
Nasal Endoscopy ◽  
Oral Antibiotic ◽  
Medical Claims ◽  
Acute Rhinosinusitis ◽  
Care Costs

Objectives. To determine the epidemiology of recurrent acute rhinosinusitis (RARS) and to understand direct health care costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis. Study Design. Retrospective longitudinal analysis of a medical claims database. Setting. Academic medical center. Methods. Medical claims data (2003–2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis claims each with a filled oral antibiotic prescription in a 12-month period) were extracted. Sinonasal diagnostic procedures, provider visits, and medical costs were determined. Results. A total of 4588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. RARS patients averaged 3.8 antibiotic prescriptions, 5.6 other sinus-related prescriptions, and 5.6 provider visits per year. Total direct health care costs related to RARS averaged $1091/patient-year, with oral antibiotic and nasal prescription costs averaging $210 and $452 per year, respectively. Conclusions. RARS may affect approximately 1 in 3000 adults per year. Despite significant direct health care costs of more than $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.

scholarly journals Returns to Operating Room After Neurosurgical Procedures in a Tertiary Care Academic Medical Center: Implications for Health Care Policy and Quality Improvement

Neurosurgery ◽  
2018 ◽  
Vol 84 (6) ◽  
pp. E392-E401
Author(s):  
Panagiotis Kerezoudis ◽  
Amy E Glasgow ◽  
Mohammed Ali Alvi ◽  
Robert J Spinner ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Operating Room ◽  
Health Care Policy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Neurosurgical Procedures ◽  
Care Policy ◽  
Academic Medical
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