scholarly journals Predicting progression from gestational diabetes to impaired glucose tolerance using peri-delivery data: an observational study

2021 ◽  
Author(s):  
Angela Bengtson ◽  
Ana Lucia Espinosa Dice ◽  
Melissa Clark ◽  
Roee Gutman ◽  
Dwight Rouse ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Observational Study ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Predictive Model ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Lasso Regression ◽  
Predictive Values

Objective: To develop a predictive model to identify women with recent gestational diabetes (GDM) most likely to progress to impaired glucose tolerance postpartum. Design: Observational study. Setting: Academic medical center in the United States. Population: Postpartum women with recent GDM, defined by Carpenter-Coustan criteria & 1-year postpartum HbA1c assessment. Methods: We used lasso regression with k-fold cross validation to develop a multivariable model to predict progression to impaired glucose tolerance, defined as HbA1c ≥ 5.7%, by 1 year postpartum. Predictive ability was assessed by the area under the curve, sensitivity, specificity, positive and negative predictive values. Main Outcome Measures: Impaired glucose tolerance. Results: Of 203 women, 71(35%) had impaired glucose tolerance at 1 year postpartum. The final model had an AUC of 0.81 (95% CI 0.74, 0.87) and included eight indicators of weight, body mass index, Hispanic ethnicity, GDM in a prior pregnancy, GDM diagnosis < 24 weeks’ gestation, and fasting and 2-hour plasma glucose at 2 days postpartum. A cut-point of ≥ 0.24 predicted probability had sensitivity 80% (95% CI 69, 89), specificity 58% (95% CI 49, 66), PPV 57% (95% CI 46, 68) and NPV 83% (95% CI 74, 89) to identify women with impaired glucose tolerance at 1 year postpartum. Conclusions: Our predictive model had reasonable ability to predict impaired glucose tolerance around delivery for women with recent GDM. Funding: National Institute of Mental Health and American Diabetes Association. Keywords: gestational diabetes, impaired glucose tolerance, type 2 diabetes prevention; predictive model

scholarly journals Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation

2021 ◽  
Vol 12 ◽  
pp. 215013272199688
Author(s):  
Ajeng J. Puspitasari ◽  
Dagoberto Heredia ◽  
Elise Weber ◽  
Hannah K Betcher ◽  
Brandon J. Coombes ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Health Services ◽  
Behavioral Health ◽  
Psychiatric Symptoms ◽  
Medical Center ◽  
Academic Medical Center ◽  
Management Training ◽  
The United States ◽  
Behavioral Health Services ◽  
Perinatal Women

Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.

scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

scholarly journals An innovative resident-driven mortality case review curriculum to teach and drive system-based practice improvements in the United States

2018 ◽  
Vol 15 ◽  
pp. 31
Author(s):  
Nila S. Radhakrishnan ◽  
Margaret C. Lo ◽  
Rohit Bishnoi ◽  
Subhankar Samal ◽  
Robert Leverence ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Systems Of Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
Case Review ◽  
Failure To Rescue ◽  
Internal Medicine Residents ◽  
Mortality Case

Purpose: Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care. Methods: Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results. Results: The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes. Conclusion: A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.

scholarly journals Depression Screening and Measurement-Based Care in Primary Care

2020 ◽  
Vol 11 ◽  
pp. 215013272093126
Author(s):  
Kimberly A. Siniscalchi ◽  
Marion E. Broome ◽  
Jason Fish ◽  
Joseph Ventimiglia ◽  
Julie Thompson ◽  
...  
Keyword(s):  
Primary Care ◽  
Task Force ◽  
Medical Center ◽  
Academic Medical Center ◽  
Unmet Need ◽  
The United States ◽  
Depression Screening ◽  
Improvement Project ◽  
Measurement Based Care

The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.

scholarly journals Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Joesph R Wiencek ◽  
Carter L Head ◽  
Costi D Sifri ◽  
Andrew S Parsons
Keyword(s):  
United States ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibody Test ◽  
The United States ◽  
Molecular Testing ◽  
Antibody Testing ◽  
Academic Medical ◽  
Public Health Epidemiology ◽  
Testing Costs

Abstract Background The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance. Methods We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC). Results Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P &lt; .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs. Conclusions Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.

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