scholarly journals Development and Validation of a Predictive Model to Evaluate the Risk of Bone Metastasis in Kidney Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Shengtao Dong ◽  
Hua Yang ◽  
Zhi-Ri Tang ◽  
Yuqi Ke ◽  
Haosheng Wang ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Kidney Cancer ◽  
Medical Center ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Training Group ◽  
Validation Group ◽  
Threshold Probability ◽  
Predictive Tool

BackgroundBone is a common target of metastasis in kidney cancer, and accurately predicting the risk of bone metastases (BMs) facilitates risk stratification and precision medicine in kidney cancer.MethodsPatients diagnosed with kidney cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database to comprise the training group from 2010 to 2017, and the validation group was drawn from our academic medical center. Univariate and multivariate logistic regression analyses explored the statistical relationships between the included variables and BM. Statistically significant risk factors were applied to develop a nomogram. Calibration plots, receiver operating characteristic (ROC) curves, probability density functions (PDF), and clinical utility curves (CUC) were used to verify the predictive performance. Kaplan-Meier (KM) curves demonstrated survival differences between two subgroups of kidney cancer with and without BMs. A convenient web calculator was provided for users via “shiny” package.ResultsA total of 43,503 patients were recruited in this study, of which 42,650 were training group cases and 853 validation group cases. The variables included in the nomogram were sex, pathological grade, T-stage, N-stage, sequence number, brain metastases, liver metastasis, pulmonary metastasis, histological type, primary site, and laterality. The calibration plots confirmed good agreement between the prediction model and the actual results. The area under the curve (AUC) values in the training and validation groups were 0.952 (95% CI, 0.950–0.954) and 0.836 (95% CI, 0.809–0.860), respectively. Based on CUC, we recommend a threshold probability of 5% to guide the diagnosis of BMs.ConclusionsThe comprehensive predictive tool consisting of nomogram and web calculator contributes to risk stratification which helped clinicians identify high-risk cases and provide personalized treatment options.

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 The Accuracy of Point-of-Care Creatinine Testing in the Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Moises Moreno ◽  
Adam Schwartz ◽  
Ronald Dvorkin
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Risk Category ◽  
Sample Population ◽  
Significant Discrepancy ◽  
Academic Medical

Objective. To determine the accuracy of Point-Of-Care testing (PoCT) creatinine values when compared to standard central laboratory testing (IDMS) and to demonstrate if and how a discrepancy could lead to improper risk stratification for contrast induced nephropathy (CIN). Methods. We conducted a descriptive retrospective chart review of patients seen in the Emergency Department of a single suburban, community, and academic medical center. We included patients who presented to the department between March 2013 and September 2014 who had blood samples analyzed by both PoCT and IDMS. Results. Mean IDMS creatinine values were 0.23 mg/dL higher when compared with i-Stat values. 95% of the time, the IDMS creatinine value was variable and ranged from −0.45 mg/dL to +0.91 mg/dL when compared to the i-Stat creatinine. When using i-Stat creatinine values to calculate GFR, 47 out of 156 patients had risk category variations compared to using the IDMS value. This affected 30.1% of the total eligible sample population (22.9% to 37.3% with 95% CI). Conclusion. We found a significant discrepancy between PoCT and IDMS creatinine values and found that this discrepancy could lead to improper risk stratification for CIN.

Assessing the Educational Efficacy of the Patient Pamphlet, Treatment Options for Avascular Necrosis of the Hip

2014 ◽  
Vol 7 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Michelle J. Lespasio ◽  
Anthony J. Guarino
Keyword(s):  
Avascular Necrosis ◽  
Domain Knowledge ◽  
Medical Center ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Racial Diversity ◽  
Basic Knowledge ◽  
Mixed Analysis ◽  
Academic Medical ◽  
Educational Efficacy

The primary purpose of this study was to assess the educational efficacy of the pamphlet Treatment Options for Avascular Necrosis of the Hip for patients with avascular necrosis (AVN). This pamphlet was designed to provide patients with information on 3 domains: (a) basic knowledge of AVN, (b) understanding of the risk factors associated with AVN, and (c) awareness of current AVN treatment options. The sample was composed of 20 AVN patients reflecting the racial diversity of the Eastern urban academic medical center. Fourteen (70%) of the patients were aware of their AVN diagnosis, and 13 (65%) reported of having conducted research on AVN. Prior to the presentation of the pamphlet, the AVN Assessment Inventory, a 13-item true/false test assessing the three domains, was answered by the patients (see Appendix A). The principal investigator presented to the sample the educational pamphlet for their review and the AVN Assessment Inventory for their answers once again. Results of the 2 (Time: pre/post) × 3 (Domain: knowledge, risks, treatment) × 2 (Diagnosed: yes/no) × 2 (Prior research: yes/no) mixed analysis of variance (ANOVA) supported the educational efficacy of the patient pamphlet Treatment Options for Avascular Necrosis of the Hip. Implications of this study are discussed.

scholarly journals Decreasing Incidence of Skin and Soft-tissue Infections in 86 US Emergency Departments, 2009–2014

2018 ◽  
Vol 68 (3) ◽  
pp. 453-459 ◽  
Author(s):  
Ethan Morgan ◽  
Sam Hohmann ◽  
Jessica P Ridgway ◽  
Robert S Daum ◽  
Michael Z David
Keyword(s):  
United States ◽  
Soft Tissue ◽  
Hiv Infection ◽  
Emergency Departments ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
The United States ◽  
Soft Tissue Infections

Abstract Background The incidence of skin and soft-tissue infections (SSTIs), for which human immunodeficiency virus (HIV) is a significant risk factor, in United States emergency departments (EDs) increased dramatically after 2000 with the emergence of community-associated methicillin-resistant Staphylococcus aureus. Few studies have examined SSTI incidence among HIV-infected and non–HIV-infected patients in the United States after 2010. Methods Data were obtained for patient encounters at all academic medical center EDs affiliated with the Vizient clinical data warehouse assigned an SSTI-associated code based on the International Classification of Diseases, Ninth Revision, between 1 January 2009 and 31 December 2014. The rate was calculated per 1000 ED encounters by year and stratified by SSTI, HIV infection, or both, and by age group, race, payer type, and region of care. Poisson regression was used to assess temporal change over the study period. Results In 2009–2014, a total of 47317 HIV-associated and 820440 SSTI-associated encounters were recorded among 25239781 ED patient encounters. The rate of SSTIs decreased by 8% among all patients and by 14.6%, among those with HIV infection. The SSTI incidence overall decreased from 32.0 to 29.7 per 1000 ED encounters between 2009 and 2014. HIV-infected patients had a significantly higher rate of SSTIs than HIV-uninfected patients (adjusted rate ratio, 1.91; 95% confidence interval, 1.84–1.99). Conclusions The decline in SSTI incidence in US EDs between 2009 and 2014 is a remarkable epidemiologic shift from the increase in SSTIs after 2000, and further research is necessary to assess reasons for this decrease.

scholarly journals Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China

2020 ◽  
Author(s):  
Qing Yang ◽  
Xiaorong Zhong ◽  
Wei Zhang ◽  
Ting Luo ◽  
Ping He ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Surgical Treatment ◽  
Early Breast Cancer ◽  
Medical Center ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Breast Conserving Surgery ◽  
Surgical Approaches ◽  
Treatment Approaches

Abstract Background Both breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients' quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aimed to evaluate the long-term cost-utilities of different surgical treatment approaches for early breast cancer. The surgical approaches are including mastectomy(MAST), breast-conserving therapy(BCT), and mastectomy with reconstruction (MAST+RECON). Methods We applied the propensity score matching method to perform a 1: 1 match on patients undergoing these three types of surgery in a tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Results The total cost of MAST, MAST+RECON and BCT was $35,282.24, $69,428.82 and $73,661.08, respectively. The discounted quality-adjusted life year(QALYs) were 17.94, 18.71 and 20.49, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $106708.06/QALY and $15050.53/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis. Conclusions We believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.

scholarly journals The Effect of Older Age on EMS Use for Transportation to an Emergency Department

2017 ◽  
Vol 32 (3) ◽  
pp. 261-268 ◽  
Author(s):  
Courtney M.C. Jones ◽  
Erin B. Wasserman ◽  
Timmy Li ◽  
Ashley Amidon ◽  
Marissa Abbott ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Risk Factor ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Older Age ◽  
Survey Study ◽  
Independent Effect ◽  
Confounding Variables

AbstractIntroductionPrevious studies have found that older adults are more likely to use Emergency Medical Services (EMS) than younger adults, but the reasons for this remain understudied.Hypothesis/ProblemThis study aimed to determine if older age is associated with using EMS for transportation to an emergency department (ED) after controlling for confounding variables.MethodsA cross-sectional survey study was conducted at a large academic medical center. Data on previous medical history, chief complaint, self-perceived illness severity, demographic information, and mode of arrival to the ED were collected on all subjects. Those who arrived to the ED via EMS also were asked reasons why they opted to call an ambulance for their illness/injury. Descriptive statistics were used to quantify survey responses, and multivariable regression was used to assess the independent effect of age on mode of ED arrival.ResultsData from 1,058 subjects were analyzed, 449 (42%) of whom arrived to the ED via EMS. Compared to adults<55 years, the unadjusted prevalence ratio for the association between age and EMS use was 1.18 (95% CI, 0.96-1.45) for subjects 55-79 years and 1.54 (95% CI, 1.18-2.02) for subjects ≥80 years. After adjustment for confounding variables, age remained a statistically significant risk factor for EMS use (P<.05).ConclusionOlder age is an independent risk factor for transportation to the ED via ambulance; however, this effect is attenuated by number of chronic medical conditions and history of depression. Additional research is needed to account for confounders unmeasured in this study and to elucidate reasons for the increased frequency of EMS use among older adults.JonesCMC, WassermanEB, LiT, AmidonA, AbbottM, ShahMN. The effect of older age on EMS use for transportation to an emergency department. Prehosp Disaster Med. 2017;32(3):261–268.

Infusion reactions following administration of intravenous rolapitant at an academic medical center

2018 ◽  
Vol 25 (7) ◽  
pp. 1776-1783 ◽  
Author(s):  
Amanda S Cass ◽  
Johlee S Odinet ◽  
John M Valgus ◽  
Daniel J Crona
Keyword(s):  
Medical Center ◽  
Phase 1 ◽  
Objective Assessment ◽  
Academic Medical Center ◽  
Treatment Strategies ◽  
Significant Risk ◽  
Hepatic Metabolism ◽  
Bioequivalence Study ◽  
Hypersensitivity Reactions ◽  
The North

In 2017, due to a fluid shortage secondary to Hurricane Maria's devastation of Puerto Rico, hospitals and health-systems began to substitute rolapitant for fosaprepitant as part of chemotherapy-induced nausea and vomiting prevention and treatment strategies. However, despite advantageous pharmacologic and formulation (e.g. long half-life, quicker time to onset, and lack of first-pass hepatic metabolism) profiles, there seems to be significant risk of infusion-related hypersensitivity reactions associated with the administration of intravenous rolapitant. In January 2018, the U.S. FDA issued a Health Care Provider Letter stating that anaphylaxis, anaphylactic shock, and other serious hypersensitivity reactions have been reported in the postmarketing setting. Importantly, these reactions were observed at a higher rate than initially reported in the phase 1 bioequivalence study that led to FDA approval of intravenous rolapitant (2.8%), with many resulting in hospitalizations. At our institution, rolapitant-induced infusion-related reactions also occurred in more patients than expected (8.7%). Described herein are six cases of infusion-related hypersensitivity reactions with intravenous rolapitant at the North Carolina Cancer Hospital. Due to the quick onset of the infusion-related hypersensitivity reactions with intravenous rolapitant, interpatient differences in pharmacokinetics or pharmacodynamics are unlikely to be the cause. An objective assessment utilizing the Naranjo Causality Scale rates these infusion-related hypersensitivity reactions as definite adverse drug reactions.

scholarly journals Development and Implementation of a COVID-19 Disease Response Protocol at a Large Academic Medical Center

2020 ◽  
pp. 1-4
Author(s):  
Meshell Maxam ◽  
Kailynn J. DeRonde ◽  
Ana D. Vega ◽  
Dimitra Skiada ◽  
Christine A. Vu ◽  
...  
Keyword(s):  
Health System ◽  
Early Recognition ◽  
Medical Center ◽  
Health Care Systems ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Routine Care ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Disease Response

ABSTRACT In response to the rapid spread of novel coronavirus disease 2019 (COVID-19), health-care systems should establish procedures for early recognition and management of suspected or confirmed cases. We describe the various steps taken for the development, implementation, and dissemination of the interdisciplinary COVID-19 protocol at Jackson Health System (JHS), a complex tertiary academic health system in Miami, Florida. Recognizing the dynamic nature of COVID-19, the protocol addresses the potential investigational treatment options and considerations for special populations. The protocol also includes infection prevention and control measures and routine care for suspected or proven COVID-19 patients.

Healthcare Workers' Knowledge and Attitudes About Pertussis and Pertussis Vaccination

2007 ◽  
Vol 28 (11) ◽  
pp. 1284-1289 ◽  
Author(s):  
William P. Goins ◽  
William Schaffner ◽  
Kathryn M. Edwards ◽  
Thomas R. Talbot
Keyword(s):  
Pertussis Vaccine ◽  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Direct Patient Care ◽  
Knowledge And Attitudes ◽  
Personal Recommendation ◽  
To Receive

Objective.To determine knowledge and attitudes about pertussis and pertussis vaccination among healthcare workers (HCWs).Design.Self-administered, Web-based survey.Setting.Tertiary-care academic medical center.Participants.Medical center employees who participated in direct patient care were recruited to complete the survey through institutional e-mail.Results.Of 14,893 potentially eligible employees, 1,819 (12%) completed the survey. Most respondents (87%) did not plan to receive the pertussis vaccine. Intent to receive vaccination (which included recent history of vaccination) was associated with the following 4 factors: receipt of a physician recommendation for vaccination (odds ratio [OR], 9.01), awareness of Centers for Disease Control and Prevention recommendations for pertussis vaccination for HCWs (OR, 6.89), receipt of encouragement to be vaccinated from a coworker (OR, 4.72), the belief that HCWs may spread pertussis to patients and family (OR, 1.80). Two factors were negatively associated with intent to receive vaccination: the presence of children in the HCW's home (OR, 0.69) and employment as a nurse (OR, 0.59). Reasons cited by those who did not intend to receive vaccination included lack of a personal recommendation for vaccination (78%), receipt of vaccination as a child (51%), and perception that there was no significant risk for contracting pertussis (38%).Conclusions.Of the HCWs surveyed, only 13% intended to receive the pertussis vaccine. A perceived lack of recommendation for vaccination and inaccurate conceptions about pertussis and pertussis vaccination were cited as reasons HCWs did not intend to be vaccinated. Institutional pertussis vaccination campaigns should focus on the risks of healthcare-associated pertussis and new recommendations for pertussis vaccination.

scholarly journals Using Intern-Led Quality Improvement to Reduce Readmissions for Specialty Service Patients Within an Academic Medical Center

2021 ◽  
Vol 4 (2) ◽  
pp. 70-76
Author(s):  
Alfeil Felipe ◽  
Anu Vats ◽  
Andressa Sleiman ◽  
Brian Tran ◽  
Miis Akel ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Patient Discharge ◽  
Clinical Service ◽  
Unplanned Readmission ◽  
Academic Medical

ABSTRACT Introduction Postdischarge patient calls are an effective intervention to decrease unplanned readmissions. Despite its efficacy, calls are time consuming and compete with other clinical obligations. The purpose of this study was to evaluate the viability of intern-led quality improvement (QI) on conducting initial postdischarge calls to filter patients who require clinical or nurse follow-up. Methods QI interns from an academic medical center's QI program completed postdischarge patient calls within 72 hours of patient discharge from a neurosurgery service between June 2018 and July 2019. QI interns filtered patients who required follow-up calls from a clinical service or nurse department. The departments called patients within 48 hours of requests. Unplanned readmission rate was compared between the cohort of patients who requested and received a follow-up call versus a cohort of patients who requested and did not receive a follow-up call (control). Results QI interns completed 83.8% postdischarge patient calls within 72 hours of discharge. Reasons for unsuccessful calls included patient unresponsiveness (74.6%), wrong phone number on file (13.9%), and request to be called at a different time (11.5%). Nurses completed 57.2% follow-up requests within the targeted 48 hours and completed remaining requests within 7 days. QI intern postdischarge follow-up calls, in conjunction with nurse follow-up intervention, showed a significant (risk ratio = −3.31, p = 0.012) preventive effect on unplanned readmission rate. Conclusions QI interns are a viable alternative to nurses to conduct the first contact of postdischarge patient follow-up calls. This system of QI interns filtering calls to the correct clinical service or nurse department increased postdischarge patient follow-up calls success rate and decreased readmission rates.

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