Predictors of Mortality and Associated Lactate Trends in Cardiogenic Shock Patients Treated with Impella® Placement - A Single Center Experience

2020 ◽  
Vol 20 ◽  
Author(s):  
Yong Ji ◽  
Amar Desai ◽  
Gary E. Fraser ◽  
Deepika Narasimha ◽  
Islam Abudayyeh ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Medical Center ◽  
Tertiary Care ◽  
Optimal Timing ◽  
Single Center Experience ◽  
Large Tertiary Care ◽  
Device Placement ◽  
The Mean ◽  
Lactate Levels ◽  
Support Devices

Background: The Impella® devices have increasingly become a desired treatment option for cardiogenic shock (CS) as demonstrated by studies analyzing real-world use of hemodynamic support devices. However, data regarding outcomes after Impella® device implant and optimal timing of device placement remains scarce. This study investigates prognostic factors including serial lactate levels in CS patients treated with Impella®.Methods: This retrospective study reviewed 76 consecutive patients diagnosed with CS supported with Impella® at a large, tertiary-care university medical center. Clinical variables and outcomes examined include co-morbidities, pre- and post-procedural lactate levels, and mortality.Results: Of the 76 patients requiring an Impella®, 70% of patients survived to hospital discharge. Those who died post-device implant had a higher prevalence of hyperlipidemia (HLD), chronic kidney disease (CKD), and more likely to require multiple (>1) vasopressors. The mean pre-procedural lactate levels were significantly higher (5.86 +/- 5.11 vs 2.16 +/- 1.50, p = 0.01) in the population who died, along with the change in lactate levels (1.90 +/- 2.56 vs -0.40 +/- 1.73, p=0.04). Those who died within 24 hours of implant showed a trend toward higher mean pre-procedural lactate levels (8.46 +/- 6.00 vs 3.86 +/- 3.31, p = 0.12).Conclusions : Higher pre-procedural lactate levels, HLD, CKD, and increased vasopressor requirement were predictive of increased mortality in CS patients post-Impella® placement, especially within 24 hours of implant. Through serial lactate measurements, we demonstrated favorable outcomes in patients with early stabilization or greater lowering of post-procedural lactate levels suggestive of improved end organ perfusion.

UPDATE ON PATIENT RADIATION DOSES AT A LARGE TERTIARY CARE MEDICAL CENTER

2001 ◽  
Vol 81 (5) ◽  
pp. 530-535 ◽  
Author(s):  
L. K. Ngutter ◽  
J. M. Koler ◽  
C. H. McCollough ◽  
R. J. Vetter
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Radiation Doses ◽  
Tertiary Care Medical Center ◽  
Large Tertiary Care

scholarly journals PGI1 PREVALENCE AND RISK FACTORS FOR DIARRHEA AT A LARGE TERTIARY CARE MEDICAL CENTER

2005 ◽  
Vol 8 (3) ◽  
pp. 369-370
Author(s):  
S Kachroo ◽  
N Kumar ◽  
G Graham ◽  
L Gerard ◽  
T Dao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center ◽  
Large Tertiary Care

Medication errors during medical emergencies in a large, tertiary care, academic medical center

Resuscitation ◽  
2012 ◽  
Vol 83 (4) ◽  
pp. 482-487 ◽  
Author(s):  
Roman Gokhman ◽  
Amy L. Seybert ◽  
Paul Phrampus ◽  
Joseph Darby ◽  
Sandra L. Kane-Gill
Keyword(s):  
Medication Errors ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Academic Medical ◽  
Large Tertiary Care ◽  
Medical Emergencies

scholarly journals Anti-tRNA synthetase syndrome interstitial lung disease: A single center experience

2021 ◽  
Author(s):  
Erin M. Wilfong ◽  
Jennifer J. Young-Glazer ◽  
Bret K. Sohn ◽  
Gabriel Schroeder ◽  
Narender Annapureddy ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Medical Center ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Trna Synthetase ◽  
Single Center Experience ◽  
Pulmonary Manifestations ◽  
Chart Abstraction

AbstractBackgroundRecognition of Anti tRNA synthetase (ARS) related interstitial lung disease (ILD) is key to ensuring patients have prompt access to immunosuppressive therapies. The purpose of this retrospective cohort study was to identify factors that may delay recognition of ARS-ILD.MethodsPatients seen at Vanderbilt University Medical Center (VUMC) between 9/17/2017-10/31/2018 were included in this observational cohort. Clinical and laboratory features were obtained via chart abstraction. Kruskal-Wallis ANOVA, Mann-Whitney U, and Fisher’s exact t tests were utilized to determine statistical significance.ResultsPatients with ARS were found to have ILD in 51.9% of cases, which was comparable to the frequency of ILD in systemic sclerosis (59.5%). The severity of FVC reduction in ARS (53.2%) was comparable to diffuse cutaneous systemic sclerosis (56.8%, p=0.48) and greater than dermatomyositis (66.9%, p=0.005) or limited cutaneous systemic sclerosis (lcSSc, 71.8%, p=0.005). Frank honeycombing was seen with ARS antibodies but not other myositis autoantibodies. ARS patients were more likely to first present to a pulmonary provider in a tertiary care setting (53.6%), likely due to fewer extrapulmonary manifestations. Only 33% of ARS-ILD were anti-nuclear antibody, rheumatoid factor, or anti-cyclic citrullinated peptide positive. Patients with ARS-ILD had a two-fold longer median time to diagnosis compared to other myositis-ILD patients (11.0 months, IQR 8.5 to 43 months vs. 5.0 months, IQR 3.0 to 9.0 months, p=0.003).ConclusionsARS patients without prominent extra-pulmonary manifestations are at high risk for not being recognized as having a connective tissue disease related ILD and miscategorized as UIP/IPF without comprehensive serologies.

scholarly journals Multisite Study to Examine the Amount of Inpatient Physician Continuity Experienced by Hospitalized Patients

2015 ◽  
Vol 7 (4) ◽  
pp. 624-629 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Siddhartha Singh ◽  
Jeff Whittle ◽  
Vishal Ratkalkar ◽  
Alexis M. Visotcky ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
General Medicine ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Inpatient Medicine ◽  
The Mean ◽  
Handoff Of Care

ABSTRACT Background Continuity for inpatient medicine has been widely discussed, but methods for measuring it have been lacking. Objective To measure the continuity of care experienced by hospitalized patients and to identify predictors of continuity. Methods This was a multisite prospective cohort study and retrospective chart review that took place at 3 hospitals: an academic tertiary care center, a Veterans Affairs medical center, and a community teaching hospital. Subjects were general medicine patients and internal medicine residents. We measured continuity of care using 3 metrics: (1) the percentage of hospital time covered by the primary intern; (2) the amount of time between admission and the first handoff of care; and (3) admission-discharge continuity. We conducted univariate analyses to identify patient and hospital factors that may be associated with each type of continuity of care. Results Our sample included 869 patients with a mean age of 62.6 years (SD = 17.2) and 34% female patients. The mean percentage of hospital time covered by the primary intern was 39.2% (SD = 16.3%). The mean time between admission and the first handoff of care was 13.3 hours (SD = 7.1). Forty percent of patients experienced admission-discharge continuity. In univariate and multivariable modeling, the site was significantly associated with each type of continuity. Conclusions The amount of continuity varied greatly and was influenced by the site and other factors. No site maximized every aspect of continuity. Programs and institutions should decide which aspects of continuity are most important locally and design schedules accordingly.

Platelet Utilization In a Tertiary Care Hospital: An Opportunity for Reduced Transfusion?

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2575-2575
Author(s):  
Vipra Sharma ◽  
Maya Shah ◽  
Ravi Pullela ◽  
Alice J. Cohen
Keyword(s):  
Disease Transmission ◽  
Tertiary Care Hospital ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Tertiary Care ◽  
Invasive Procedure ◽  
Care Hospital ◽  
Tertiary Care Medical Center ◽  
The Mean ◽  
Transfusion Guidelines

Abstract Abstract 2575 Background: Use of platelet (plt) transfusions to treat and prevent bleeding varies widely between hospitals and by medical and surgical services. Standard indications include active bleeding with thrombocytopenia or plt dysfunction, pre or peri-invasive procedure, and prophylaxis for low plt counts. Rising demand for plt transfusions and donor shortage, coupled with the risks of transfusion (including infectious disease transmission and alloimmunization) are concerns which often lead to strict regulation of plt transfusion in hospitals. In order to evaluate appropriate use of plt transfusion based on Newark Beth Israel Medical Center transfusion guidelines, a review of plt use was undertaken at this tertiary care hospital. Design: A retrospective review was performed of plt utilization over a 3 month period from October to December 2009. All charts of hospitalized and outpatient patients receiving plt transfusions were reviewed to determine reasons for plt transfusion. Pre-transfusion plt values, site/service ordering plt transfusions, number of units transfused and cost were determined. Results: 421 plt units were transfused to 125 patients (51.6% female), mean age 44 years (yrs.) (range 0–89). All plt transfusions were single donor units. The mean plt count prior to transfusion for all procedures was 127,000, well above hospital guidelines. The majority of plt utilized were by cardiothoracic (CT) surgery (168/421, 40%) with the highest cost (Table 1). 124/421(29%) of transfusions occurred pre- or peri- invasive procedure, with 88/124 (71%) of those transfusions occurring prior or peri- cardio-thoracic procedure. 83/421 (20%) of transfusions had no clear indication based on hospital guidelines, predominately ordered by CT surgery and occurring post-op for asymptomatic thrombocytopenia (cost $45, 650). The mean plt count at which transfusion was found to have no indication was 55,000 (range 25,000–105,000). 136/421(32%) of the cases were prophylactic transfusions with a plt count < 20,000, with 121/136 (89%) in the oncology patients, and the rest in the medical pts due to sepsis. 114/421(27%) of the transfusions were for bleeding. Only 5 patients, 3 in the CT group, and 2 in neonate group had plt dysfunction as the indication for transfusion prior to procedure. The lowest incidence of plt transfusions without an indication was in the adult oncology department. Conclusion: Platelet utilization varied by departments. CT surgery followed by neonatal and pediatric oncology are the principal users of plt in our tertiary care medical center. CT surgery, general surgery, and neonatal services had the highest pre-transfusion plt counts. As 20% of all transfusions had no clinical reason for plt use (no bleeding, invasive procedure, or severely low plt count) the opportunities may exist for lower platelet usage by educating physicians about compliance to transfusion guidelines in order to decrease the risks associated with transfusion and resultant complications. Disclosure: No relevant conflicts of interest to declare.

Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

2012 ◽  
Vol 33 (4) ◽  
pp. 338-345 ◽  
Author(s):  
Harold C. Standiford ◽  
Shannon Chan ◽  
Megan Tripoli ◽  
Elizabeth Weekes ◽  
Graeme N. Forrest
Keyword(s):  
Infectious Diseases ◽  
Cost Analysis ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Fiscal Year ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Large Tertiary Care

Background.An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.Design.A descriptive cost analysis before, during, and after the program.Patients/Setting.A large tertiary care teaching medical center.Methods.Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.Results.The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.Conclusions.The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

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