scholarly journals Placenta previa rates in relation to prior cesarean section deliveries, A 15-year single-center analysis

2020 ◽  
Author(s):  
Ahmad B. Alwazzan ◽  
abdullah Kafy ◽  
Samera F. AlBasri ◽  
Ahmed A. Mousa ◽  
Lujain K. Halawani ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Medical Center ◽  
Placenta Previa ◽  
Academic Medical Center ◽  
University Hospital ◽  
Positive Correlation ◽  
Academic Medical ◽  
Number Of Patients ◽  
King Abdulaziz University ◽  
Prior Cesarean Section

Abstract Background: To estimate the rate of placenta previa in relation to prior delivery via cesarean section (CS) during a 15-year period in an academic medical center, King Abdulaziz University Hospital (KAUH), in Jeddah, Saudi Arabia.Methods: In this retrospective study, we reviewed the medical records of all pregnant women who delivered at KAUH from January 2001 to December 2015. For each year, the research team recorded the total number of deliveries, as well as the number and percentage of CS deliveries and patients with placenta previa. The association between placenta previa and previous CS was assessed. Results: Out of the 62,701 deliveries at KAUH during the study period, 13,404 were CS deliveries, producing an overall CS rate of 21.4%. The total number of patients with placenta previa was 260, for a placenta previa rate of 4.14 cases/1,000 births. Of patients with placenta previa, 135 had a prior CS (60%), whereas 91 multigravida women had no previous CS (40%).There is positive correlation between number of CS and number of placenta pravia.Conclusion: In spite of, significant positive correlation between number of CS and number of placenta previa. The rate of placenta previa was not significantly different between patients with or without prior CS delivery. This suggests that factors other with previous CS could play role in the development of placenta previa especially in primgravida.

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 Epidemiology of Hospital-Acquired Urinary Tract–Related Bloodstream Infection at a University Hospital

2011 ◽  
Vol 32 (11) ◽  
pp. 1127-1129 ◽  
Author(s):  
Robert Chang ◽  
M. Todd Greene ◽  
Carol E. Chenoweth ◽  
Latoya Kuhn ◽  
Emily Shuman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Bloodstream Infection ◽  
Case Fatality Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Case Fatality ◽  
University Hospital ◽  
Academic Medical ◽  
Hospital Acquired

Little is known about the epidemiology of nosocomial urinary tract-related bloodstream infection. In a case series from an academic medical center, Enterococcus (28.7%) and Candida (19.6%) species were the predominant microorganisms, which suggests a potential shift from gram-negative microorganisms. A case-fatality rate of 32.8% highlights the severity of this condition.

Intravenous Immune Globulin Stewardship Program at a Tertiary Academic Medical Center

2016 ◽  
Vol 51 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Megan A. Rocchio ◽  
James W. Schurr ◽  
Aaron P. Hussey ◽  
Paul M. Szumita
Keyword(s):  
Immune Globulin ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intravenous Immune Globulin ◽  
Solid Organ ◽  
Organ Rejection ◽  
Guideline Compliance ◽  
Stewardship Program ◽  
Academic Medical ◽  
Number Of Patients

Background: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women’s Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. Objective: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. Methods: This was a prospective, observational study from January 2013 through December 2014. All patients ordered to receive IVIG during the defined study period were included. The intervention assessed describes a pharmacist-driven IVIG stewardship program for medication approval. The primary end point was guideline compliance based on indication, dose, dosing weight, and frequency. Secondary end points included the number of patients receiving IVIG, indications, orders discontinued as a result of guideline nonadherence, and total amount dispensed. Results: A total of 418 patients were identified during the study time frame. The top indications were: hypogammaglobulinemia in bone marrow transplantation and hematological malignancy (50.7%), acute solid organ rejection (11.8%), and immune thrombocytopenia with bleeding (10.1%). In all, 12 patients (2.9%) received IVIG for an indication nonadherent with the IVIG prescribing guideline; 9 patients (2.2%) and 2 patients (0.5%), respectively, received a different dose or frequency per the prescribed indication; and 12 orders (2.9%) for indications nonadherent to the guideline were discontinued. A total of 26 033 g of IVIG were dispensed during the study period. Conclusions: An IVIG stewardship program, including an institution-specific prescribing guideline and a pharmacist-driven stewardship program, may ensure guideline compliance for appropriateness of indication and dose at an academic medical center.

Evaluation of inpatient cancer pain management at an academic medical center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 128-128
Author(s):  
Michael Mearis ◽  
Joseph Shega ◽  
Randall Knoebel
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Pain Management ◽  
Nccn Guidelines ◽  
Academic Medical ◽  
Number Of Patients ◽  
Increased Risk ◽  
Cancer Network

128 Background: The National Comprehensive Cancer Network (NCCN) guidelines on cancer pain management were developed to direct pain assessment and management. The purpose of this study was to assess whether adherence to guidelines was associated with improved outcomes. Methods: One-hundred and nine patients admitted to the inpatient hematology oncology service that received at least one dose of morphine, oxycodone, or hydromorphone were evaluated and allocated into groups based on adherence to the NCCN guidelines. Safety and achievement of analgesia (pain score ≤ 4) at 24-hours after opioid initiation were compared between the two groups. A multivariate analysis was performed to identify predictors of opioid regimens non-adherent to guidelines. Results: Sixty-four percent of patients were initiated on regimens adherent to the NCCN guidelines. 63% of patients initiated on regimens adherent to NCCN guidelines reached the endpoint of analgesia at 24 hours compared to 41% of those who were not (p = 0.028). Adverse events were infrequent (p > 0.5). Opioid tolerance was the variable most predictive of being initiated on regimens non-adherent to guideline recommendations (OR 3.1, 95% confidence interval 1.24-7.82). Conclusions: A significant number of patients presenting with cancer pain are initiated on regimens non-adherent to NCCN guidelines, leading to reduced attainment of adequate analgesia. Opioid tolerant patients are at an increased risk of inadequate analgesia, and should be identified and initiated on proper pain regimens taking home opioid usage into consideration.

Abstract 247: Process Improvement Initiatives to Reduce No Show Rates in Rural Communities

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Tara Haskell ◽  
Melissa Cushman
Keyword(s):  
Rural Communities ◽  
Process Improvement ◽  
Private Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Recommended Care ◽  
Academic Medical ◽  
Improved Outcomes ◽  
Number Of Patients ◽  
Data Tracking

Objective: A large pediatric academic medical center (AMC) acquired an out-of-state private cardiology practice serving rural communities and without an EMR. No show rates at the private practice consistently ranged from 20-40%, compared to 11% at the AMC. No shows contribute to inefficient use of clinician time and access to care challenges for other patients. Upon acquisition, process improvement efforts began with the goal of decreasing the abnormally high no show rates. Methods/Findings: Under private practice, staff scheduled patient appointments without inquiring for their availability and then notified patients of their appointment date and time via letter 10 days prior to the scheduled appointment and then by phone 2 days prior to the appointment. Immediately following the acquisition in December 2018, staff began calling patients to inquire when they would like to be scheduled based on their availability. Patients were scheduled six months out, so the true impact of this process change would be fully realized in May 2019. Once an EMR was implemented, a dashboard was created to monitor no show rate data and identify trends. After six months, no show rates only slightly improved, so in addition to the automated emails, calls, or text reminders from the scheduling center, a dedicated staff member began making reminder calls to patients the day before their appointment. As a result of the process improvement efforts, no show rates decreased from a high of 42% to 16% in eight months. Further, to better understand why patients were not showing for their appointments, staff began calling patients after a no-show appointment to determine if there were barriers for not showing and offering to reschedule the appointment. Data collected shows that out of 470 no show appointments from May 2019 to December 2019, 117 patients had disconnected phone numbers, 230 had appointment reminder messages left on their voicemail, 68 did not answer the call and did not have voicemail to leave a message and 55 patients confirmed their appointment with staff, but did not show for the appointment. Of the 470 no shows, 394 were pediatric patients and 76 were adults. Data shows 185 out of 470, or 39% of reminders never reached the patient, and an additional 49% went to voicemail and may not have been heard. Conclusion: No show appointments negatively impact clinic efficiencies and the ability to provide care to the greatest number of patients. When a patient doesn’t show for their appointment, they are non-compliant with their recommended care and reserve a clinic appointment that another patient may need. Small tests of change were made in phases to ensure appointments were convenient for patients and families and metrics were set and tracked to monitor improvement. By implementing new patient-centric processes and data tracking, more patients in rural communities receive the required follow up CHD care, leading to improved outcomes.

scholarly journals 769. Risk Factors of Central Line-associated Bloodstream Infection in an Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S481-S482
Author(s):  
Zane Conrad ◽  
Minji Kang ◽  
Elizabeth Thomas ◽  
Doramarie Arocha ◽  
Julie B Trivedi
Keyword(s):  
Risk Factors ◽  
Candida Species ◽  
Medical Center ◽  
Academic Medical Center ◽  
Central Line ◽  
University Hospital ◽  
Icu Patients ◽  
Academic Medical ◽  
Significant Difference ◽  
Line Type

Abstract Background Central line-associated bloodstream infections (CLABSI) are one of the leading healthcare-acquired infections (HAI) with significant morbidity and mortality. We aimed to identify risk factors of CLABSI at an academic medical center to determine high-risk populations and target interventions. Methods This is an observational retrospective cohort study at William P. Clements Jr. University Hospital from January 1, 2017 to December 31, 2020. Retrospective chart review was conducted to identify demographics and co-morbidities of hospitalized patients diagnosed with CLABSI as defined by National Healthcare Safety Network (NHSN). Infections due to mucosal barrier injuries were excluded. Means were compared using independent-samples T-test and proportions were compared using chi-square. Results Ninety-three CLABSI events were identified with an increase in the standardized infection ratio from 0.38 in 2017 to 0.74 in 2020 (Figure 1). Bacterial organisms were identified in 71 (76%) cases while fungal organisms were identified in 22 (24%) (Table 2). There was no significant difference in the timing of CLABSI after line insertion (p=0.09) or organism identified (p=0.61) in PICC lines (n=33, 34%) vs all other central lines (n=60, 67%). When comparing immunocompromised patients with CLABSI (n=47, 51%) vs non-immunocompromised (n=46, 50%), there was a significant difference in the indication for line (chemotherapy), but no difference was seen in the number of line days prior to event (p=0.57), line type (p=0.17), or organism identified (p=0.94). Of all CLABSI, 46% (n=43) were in the intensive care unit (ICU) with significantly more Candida species (p=0.018) identified compared to non-ICU patients with CLABSI (n= 50, 54%). Figure 1. CLABSI Rate and SIR from 2017 to 2020 by Quarter Conclusion Candida species were more likely to be found in ICU patients with CLABSI as compared to non-ICU counterparts with further investigation in the ICU population revealing lack of flushing after administration of total parenteral nutrition. Otherwise, this observational cohort of CLABSI events did not identify any difference in immunosuppression status or line type. Given this information, infection prevention efforts will continue to be directed towards proper central line maintenance and removal when no longer indicated. Disclosures All Authors: No reported disclosures

Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center

2018 ◽  
Vol 34 (9) ◽  
pp. 707-713 ◽  
Author(s):  
Alexander H. Flannery ◽  
Melissa L. Thompson Bastin ◽  
Ashley Montgomery-Yates ◽  
Corrine Hook ◽  
Evan Cassity ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Successful Implementation ◽  
Multidisciplinary Meeting ◽  
Continuous Quality ◽  
Academic Medical ◽  
Number Of Patients ◽  
Benzodiazepine Use

Background: Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. Methods: This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. Results: The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. Conclusions: A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.

Implementation and Evaluation of a Smartphone Application for the Perioperative Care of Neurosurgery Patients at an Academic Medical Center: Implications for Patient Satisfaction, Surgery Cancelations, and Readmissions

2017 ◽  
Vol 14 (3) ◽  
pp. 303-311 ◽  
Author(s):  
Daniel R Felbaum ◽  
Jeffrey J Stewart ◽  
Amjad N Anaizi ◽  
Faheem A Sandhu ◽  
Mani N Nair ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Medical Center ◽  
Academic Medical Center ◽  
Smartphone Application ◽  
Control Group ◽  
Pain Scores ◽  
Phone Calls ◽  
Academic Medical ◽  
Number Of Patients ◽  
Before And After

Abstract BACKGROUND Smartphone applications (apps) in the health care arena are being increasingly developed with the aim of benefiting both patients and their physicians. The delivery of adequate instructions both before and after a procedure or surgery is of paramount importance in ensuring the best possible outcome for patients. OBJECTIVE To demonstrate that app-based instructions with built-in reminders may improve patient understanding and compliance and contribute to reducing the number of surgery cancellations and postoperative complications and readmissions. METHODS We prospectively accrued 56 patients undergoing routine neurosurgery procedures who subsequently downloaded the app. The median age was 54 (range 27-79). Patients were followed for successful registration and use of the app, compliance with reading instructions before and after surgery, and sending pain scores and/or wound images. The number of surgeries cancelled, postoperative complications, 30-d readmissions, and phone calls for surgery-related questions were examined. RESULTS Fifty-four of the 56 patients successfully registered, downloaded, and used the app and read and complied with instructions both before and after surgery. There were no cancelled surgeries. There was 1 postoperative complication. There were no readmissions. Eight of the 54 patients (14.8%) called the office on a single occasion for a surgery related question. CONCLUSION We demonstrate the utility of a smartphone application in the perioperative neurosurgical care setting with regard to patient compliance and satisfaction as well as surgery cancellations and readmissions. Further study of a larger number of patients with a control group is warranted.

scholarly journals Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital

2015 ◽  
Vol 9 (5) ◽  
pp. 558-567 ◽  
Author(s):  
Carl H. Schultz ◽  
Kristi L. Koenig ◽  
Wajdan Alassaf
Keyword(s):  
Public Health ◽  
Medical Center ◽  
Health Care Systems ◽  
Academic Medical Center ◽  
Medical Personnel ◽  
University Hospital ◽  
Treatment Center ◽  
Treatment Unit ◽  
Academic Medical ◽  
Care Systems

AbstractAs Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

Pneumatized Crista Galli: A Histopathologic Study

2020 ◽  
Vol 163 (3) ◽  
pp. 517-521
Author(s):  
Marcel Marjanovic Kavanagh ◽  
Tomislav Tokic ◽  
Antonia Jakovcevic ◽  
Ranko Smiljanic ◽  
Boris Bumber ◽  
...  
Keyword(s):  
Chronic Inflammation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Importance ◽  
University Hospital ◽  
Thin Sections ◽  
Histopathologic Study ◽  
Academic Medical ◽  
Hematoxylin And Eosin ◽  
The University

Objective This is the first histopathologic study that investigates the incidence of the pneumatized crista galli. Study Design A prospective histopathologic study. Setting Tertiary academic medical center. Subjects and Methods A total of 109 specimens of crista galli were obtained postmortem during 2018 from randomly chosen patients who died at the University Hospital Centre Zagreb and had an autopsy at our Department of Pathology and Cytology. Specimens were surgically resected during the autopsy and then fixed, decalcinated, dehydrated, and embedded in paraffin. All slides were cut into 5-µm-thin sections and stained with a standard method (hematoxylin and eosin) for light microscope analysis. Specimens were histopathologically analyzed for the existence of pneumatization inside crista galli. The criterion to declare a specimen pneumatized was the presence of mucosa inside the cavity. Results Pneumatized crista galli was found in 5 of 109 specimens (4.59%). In 5 of 5 cases (100%) of pneumatized crista galli, there was evidence of chronic inflammation. Conclusion We found that the incidence of pneumatized crista galli is significantly lower in our histopathologic study in comparison with the majority of previous radiologic studies. Our study also found that all 5 specimens with pneumatized crista galli had chronic inflammation in the mucosa, which is a considerably higher incidence than in the previous studies (7.7%-44%). Due to the emerging evidence of pneumatized crista galli being of clinical importance, we suggest that a larger study be conducted before the results are generalized to the general population.

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