History of the Academic Medical Center

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.

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Independent risk factors for chronic illicit substance use during pregnancy

Journal of Opioid Management ◽

10.5055/jom.2020.0590 ◽

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.

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The Prescribing and Education of Naloxone in a Large Academic Medical Center

Pharmacy ◽

10.3390/pharmacy8010031 ◽

2020 ◽

Vol 8 (1) ◽

pp. 31

Author(s):

Sabrina Miller ◽

Lauren Williams ◽

Amy N. Thompson

Keyword(s):

Medical Center ◽

Demographic Data ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Reversal Agents ◽

Outpatient Prescription ◽

Current State ◽

Academic Medical ◽

History Of ◽

Improvement Measures

The opioid epidemic has led to increased needs for opioid reversal agents which require education and counseling for proper use. The purpose of this study was to evaluate outpatient naloxone prescribing and education practices at an academic medical center to understand the current state and inform quality improvement measures. This retrospective chart review study included 439 patients that were at least 18 years old and received an outpatient prescription for naloxone between 1 July 2017 and 30 June 2018. Descriptive and demographic data were collected. The primary endpoint was whether an indication for naloxone and education on administration were documented when naloxone was initially prescribed to patients. Overall, 39% of naloxone prescriptions did not have an indication for prescribing listed in the medical record. Of those with a documented indication, concomitant benzodiazepines and history of overdose or substance abuse were most common (22% and 14%). The average morphine milligram equivalents were 165. Additionally, 69% of dispenses did not have documentation that the patient or a caregiver received education regarding the use and administration of naloxone. These findings suggest that patients are receiving naloxone for appropriate indications. Documentation of medication education is needed to ensure it is occurring and that patients are informed.

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Otolaryngologists and the Early Diagnosis of Mucopolysaccharidoses: A Cross-Sectional Study

Diagnostics ◽

10.3390/diagnostics9040187 ◽

2019 ◽

Vol 9 (4) ◽

pp. 187 ◽

Cited By ~ 1

Author(s):

Danielle de Araujo Torres ◽

Anneliese Lopes Barth ◽

Mariana Pires de Mello Valente ◽

Paulo Pires de Mello ◽

Dafne Dain Gandelman Horovitz

Keyword(s):

Chart Review ◽

Medical Center ◽

Academic Medical Center ◽

Cross Sectional Study ◽

Inborn Errors ◽

Cross Sectional ◽

Academic Medical ◽

Fatal Course ◽

History Of ◽

Nose And Throat

Mucopolysaccharidoses (MPS) are a group of inborn errors of metabolism with an aggressive and usually fatal course. Therefore, early treatment is essential because the involvement of head and neck structures is almost always present in MPS. Our study aimed to retrospectively assess—via a chart review and a survey of caregivers—the history of ear, nose and throat (ENT) symptoms, the number of otolaryngology visits prior to diagnosis, and whether otolaryngologists diagnosed the disease in a cohort of MPS patients followed at an academic medical center. Twenty-three patients were evaluated. Age at diagnosis ranged from 0.2 to 33.0 years (median, 3.2 years). Prior to being diagnosed with MPS, 20/23 (87%) patients presented with at least one episode of otalgia, airway disorder, sleep disturbance, speech delay or suspected hearing loss. One patient had an adenotonsillectomy with paracentesis of tympanic membranes. Ten of the 23 patients (43%) were seen by an otolaryngologist before the diagnosis of MPS, none of which had the disease suspected during these visits. Notwithstanding limitations, our results suggest that increased awareness of MPS among otolaryngologists may allow for earlier diagnosis and better management of these patients.

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C-07 Global Precedence: Examining Contributing Effects of Age and Cognitive Functioning

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.169 ◽

2019 ◽

Vol 34 (6) ◽

pp. 1034-1034

Author(s):

M Johnson ◽

J Lai ◽

M Corona ◽

G Lupas

Keyword(s):

Cognitive Functioning ◽

Medical Center ◽

Linear Regression Analysis ◽

Academic Medical Center ◽

Clinical History ◽

Global Precedence ◽

Academic Medical ◽

Mini Mental Status Examination ◽

History Of ◽

Global And Local

Abstract Objective Global precedence (GP) is an individual’s ability to readily identify global (gestalt) features when both global and local (internal) details are presented. Prior research shows that both age and neurodegenerative diseases, such as Alzheimer’s, affect GP. The goal of the current study is to examine differences in GP between individuals with early-onset Alzheimer’s disease (EOAD; before age 65) and healthy controls (HC). Method Fourteen EOAD patients and 6 HC’s recruited from Behavioral Neurology at an academic medical center were included in the current analysis. EOAD participants were diagnosed by clinical history, routine labs, neuroimaging, and neurological examination. Exclusion criteria included unstable medical conditions and history of severe head injury, psychotic disorder, or psychoactive substance use. All participants completed a Mini Mental Status Examination (MMSE) to assess overall cognitive functioning and a 4-item Navon's paradigm task (consisting of a larger letter whose shape is composed of smaller repeats of a different letter) to assess for GP. Results Linear regression analysis was performed, with the total score on Navon task as the dependent variable and age, MMSE score, and study group as predictor variables. Analysis yielded significant findings, suggesting a difference in GP performance between the two groups. However, coefficients suggested that while age did not contribute to the between-group difference, MMSE scores significantly accounted for our findings. In fact, when effects of MMSE scores were controlled, the between-group difference was no longer significant. Conclusion Findings suggest that individuals with EOAD perform worse on tasks of GP, which may be secondary to overall cognitive decline.

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Patient Perceptions of Open, Laparoscopic, and Robotic Gynecological Surgeries

BioMed Research International ◽

10.1155/2016/4284093 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Mohamad Irani ◽

Cheruba Prabakar ◽

Sepide Nematian ◽

Nitasha Julka ◽

Devika Bhatt ◽

...

Keyword(s):

Health Care Providers ◽

Medical Center ◽

Academic Medical Center ◽

Surgical Approaches ◽

Care Providers ◽

Institutional Review ◽

Academic Medical ◽

History Of ◽

The Difference ◽

Gynecological Care

Objective. To investigate patient knowledge and attitudes toward surgical approaches in gynecology. Design. An anonymous Institutional Review Board (IRB) approved questionnaire survey. Patients/Setting. A total of 219 women seeking obstetrical and gynecological care in two offices affiliated with an academic medical center. Results. Thirty-four percent of the participants did not understand the difference between open and laparoscopic surgeries. 56% of the participants knew that laparoscopy is a better surgical approach for patients than open abdominal surgeries, while 37% thought that laparoscopy requires the surgeon to have a higher technical skill. 46% of the participants do not understand the difference between laparoscopic and robotic procedures. 67.5% of the participants did not know that the surgeon moves the robot’s arms to perform the surgery. Higher educational level and/or history of previous abdominal surgeries were associated with the highest rates of answering all the questions correctly (p<0.05), after controlling for age and race. Conclusions. A substantial percentage of patients do not understand the difference between various surgical approaches. Health care providers should not assume that their patients have an adequate understanding of their surgical options and accordingly should educate them about those options so they can make truly informed decisions.

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Characteristics of Conversion Disorder in an Urban Academic Children’s Medical Center

Clinical Pediatrics ◽

10.1177/0009922819857541 ◽

2019 ◽

Vol 58 (11-12) ◽

pp. 1250-1254 ◽

Cited By ~ 1

Author(s):

Ayol Samuels ◽

Tali Tuvia ◽

Daniel Patterson ◽

Olga Briklin ◽

Scott Shaffer ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Conversion Disorder ◽

Minority Population ◽

Female Ratio ◽

Academic Impairment ◽

High Resource ◽

Academic Medical ◽

History Of ◽

Male To Female

Background. Literature on childhood conversion disorder (CD) is sparse and is mostly limited to the outpatient population. Method. Our study retrospectively examines the characteristics of childhood CD in 42 children and adolescents seen by the psychiatric consultation-liaison service in an urban academic medical center with a large minority population. Results. CD accounted for 11% of our consultations. The majority of patients were female adolescents, but in the younger cohort, the male-to-female ratio equalized. Other somatic symptoms and additional psychiatric diagnoses were common, anxiety disorders in particular. Antecedent stressors were identified in 95% of patients, most commonly related to family stressors. Recent or remote history of abuse was rare. Neurological presentations were complex, with almost half of the patients presenting with multiple distinct neurological symptoms. Hyperkinetic symptoms were more common than hypokinetic symptoms, and paroxysmal symptoms were more common than non-paroxysmal. No distress (la belle indifference) was found in only 25% of patients and about half of patients had no socio-academic impairment. High resource utilization was noted based on multiple specialist consultants, diagnostic studies, and length of stay. Conclusion. Much of our data confirms previous findings and contributes to what is becoming a more robust characterization of this population.

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Building bridges between a community and an academic medical center via community tours

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.7 ◽

2020 ◽

Vol 4 (4) ◽

pp. 294-300

Author(s):

Megan B. Irby ◽

Keena R. Moore ◽

DeWanna Hamlin ◽

Olivia Brown ◽

Grisel Trejo ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Community Assets ◽

Marginalized Communities ◽

Community Needs ◽

Medical Centers ◽

Academic Medical ◽

History Of ◽

Conducting Research ◽

Work Supports

AbstractAcademic medical centers (AMCs) face challenges in conducting research among traditionally marginalized communities due to long-standing community mistrust. Evidence suggests that some AMC faculty and staff lack an understanding of the history of distrust and social determinants of health (SDH) affecting their communities. Wake Forest Clinical and Translational Science Institute Program in Community Engagement (PCE) aims to build bridges between communities and Wake Forest Baptist Health by equipping faculty, clinicians, administrators, and staff (FCAS) with a better understanding of SDH. The PCE collaborated with community partners to develop and implement community tours to improve cross-community AMC understanding and communication, enhance knowledge of SDH, and build awareness of community needs, priorities, and assets. Nine day-long tours have been conducted with 92 FCAS. Tours included routes through under-resourced neighborhoods and visits to community assets. Participant evaluations assessed program quality; 89% reported enhanced understanding of access-to-care barriers and how SDH affect health; 86% acknowledged the experience would improve future interactions with participants and patients; and 96% agreed they would recommend the tour to colleagues. This work supports the use of community tours as a strategy to improve cross-community AMC communication, build trust, and raise awareness of community needs, priorities, and assets.

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