Benign Endobronchial Tumors: A Clinicopathologic Review

Purpose: Benign endobronchial tumors are rare entities that can be difficult to diagnose because they often present with non-specific symptoms and vague radiographic findings. The current study reviews the clinical, radiologic and pathologic features, diagnosis, and treatment of patients with benign endobronchial tumors.Methods: We examined the charts of all patients who presented with biopsy-proven benign endobronchial tumors at a tertiary-care academic medical center between 1993 and 2018. Pertinent clinicopathologic and radiologic data were analyzed, with particular attention paid to treatment modalities and mean overall patient survival.Results: A total of 28 cases were identified. The most common benign neoplasm was hamartoma (37%), followed by lipoma (19%), squamous papilloma (11%), pleomorphic adenoma (7%), mucin gland adenoma (7%), papillary adenoma (3%), hemangioma (3%), neurofibroma (3%), leiomyoma (3%), and papillomatosis (3%). Cough (58%), shortness of breath (44%), and hemoptysis (15%) were the most frequent presentations. Most cases demonstrated well-defined submucosal or pedunculated endobronchial lesions with segmental pneumonia or atelectasis on imaging. Histologic diagnosis was obtained by endobronchial resection in 43% of patients, thoracoscopic lobectomy in 36%, endobronchial biopsy in 18%, and thoracoscopic wedge resections in 3%. All procedures were performed with no intraoperative or in-hospital deaths (mean overall survival: 20.2 years).Conclusion: Benign endobronchial tumors typically present as well-defined submucosal and/or pedunculated lesions, and may lead to post-obstructive complications. Endobronchial resection is the preferred strategy for diagnosis and treatment of these tumors.

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S217 – Neurotologic Features of Temporomandibular Joint Tumors

Otolaryngology ◽

10.1016/j.otohns.2008.05.392 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P148-P148

Author(s):

John P Leonetti ◽

Sam Marzo ◽

Ryan G Porter

Keyword(s):

Temporomandibular Joint ◽

Medical Center ◽

Treatment Plan ◽

Academic Medical Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Synovial Chondromatosis ◽

Primary Tumors ◽

Radiographic Findings ◽

Complete Physical Examination

Objectives To present the clinical and radiographic findings in 8 patients with unusual primary tumors of the temporomandibular joint (TMJ). Methods This was a retrospective chart review of all patients with neurotologic manifestations caused by primary TMJ tumors seen at our tertiary care, academic medical center between 7/88-; 7/07. Results 8 patients were identified with primary TMJ tumors that caused a variety of neurotologic manifestations, including trismus, otalgia, tinnitus, hearing loss, aural fullness, headache, facial pain, and otorrhea. Tumor histology included chondroma, chondroblastoma, osteoma, giant cell tumor, synovial chondromatosis, and osteosarcoma. Anterior external auditory canal involvement required partial petrosectomy in all 8 patients. Despite aggressive surgical resection and radiotherapy, only 5 of 8 patients are disease-free, with a mean follow-up of 7.2 years. Conclusions Primary tumors of the TMJ, although rare, can cause a variety of common neurotologic manifestations. A complete physical examination with appropriate radiographic assessment will guide the proper treatment plan. Earlier diagnosis may lead to improved overall control rates.

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Small Bowel Tumors: Clinical Presentation, Prognosis, and Outcome in 33 Patients in a Tertiary Care Center

Journal of Oncology ◽

10.1155/2008/212067 ◽

2008 ◽

Vol 2008 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Mirna H. Farhat ◽

Ali I. Shamseddine ◽

Kassem A. Barada

Keyword(s):

Small Bowel ◽

Clinical Presentation ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Treatment Modalities ◽

R0 Resection ◽

Small Bowel Tumors ◽

Stromal Tumors ◽

Pathologic Features

Introduction. Small bowel cancers are rare. Accumulation of data regarding their clinical presentation, pathologic features, prognostic factors, treatment modalities, and outcome is difficult.Methods. This is a retrospective study of the medical records of 33 patients with small bowel cancers treated at the American University of Beirut-Medical Center over a 20-year period.Results. The study included 25 males (76%) and 8 females (24%). Median age at presentation was 56 years. Most common symptoms were abdominal pain (66.7%) and weight loss (57.6%). Thirteen patients presented with abdominal emergencies (39.3%). Lymphoma was the most common malignant tumor (36.4%), followed by adenocarcinoma (33.3%), leiomyosarcoma (15.2%), gastrointestinal stromal tumors (12.1%), and neuroendocrine tumors (3.0%). Tumors were located in the duodenum in 30% of patients, jejunum in 33%, and ileum in 36%. Resectability rate was 72.7% and curative R0 resection was achieved in 54.1% (13/24) of patients. 5-year survival of the 33 patients was 24.2%.Conclusion. Small bowel cancers are difficult to diagnose because of the nonspecific symptoms. Most patients present with advanced disease and have poor prognosis. Adenocarcinoma and duodenal location have the worst 5-year survival in contrast to stromal tumors and those with ileal location which have the best survival.

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Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients

Journal of Wrist Surgery ◽

10.1055/s-0037-1606124 ◽

2017 ◽

Vol 07 (02) ◽

pp. 115-120 ◽

Cited By ~ 1

Author(s):

Tiffany Liu ◽

Chia Wu ◽

David Steinberg ◽

David Bozentka ◽

L. Levin ◽

...

Keyword(s):

Physical Examination ◽

Medical Center ◽

Academic Medical Center ◽

Diagnostic Study ◽

Level Of Evidence ◽

Radiographic Findings ◽

Academic Medical ◽

De Quervain ◽

Clinical Records ◽

Surgical Release

Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT). Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice. Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs. Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically. Conclusion Wrist radiography does not influence management of patients presenting DQT. Level of Evidence This is a level III, diagnostic study.

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Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.695 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s168-s169

Author(s):

Rebecca Choudhury ◽

Ronald Beaulieu ◽

Thomas Talbot ◽

George Nelson

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Antibiotic Use ◽

Care Hospital ◽

Hospital Units ◽

Antibiotic Utilization ◽

Academic Medical ◽

Level Data ◽

Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

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Implementation of a Leeches + Antimicrobial Prophylaxis Order Panel to Optimize Medicinal Leech Use at a Tertiary Care Academic Medical Center

Journal of Pharmacy Practice ◽

10.1177/0897190021993683 ◽

2021 ◽

pp. 089719002199368

Author(s):

Nicole M. Palm ◽

Jill C. Wesolowski ◽

Janet Y. Wu ◽

Pavithra Srinivas

Keyword(s):

Antimicrobial Prophylaxis ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Medicinal Leech ◽

Aeromonas Species ◽

Leech Therapy ◽

Before And After ◽

Timing Of Initiation ◽

Medicinal Leeches

Medicinal leech therapy promotes vascular flow and can be used to salvage grafts. Medicinal leeches have a symbiotic relationship with Aeromonas species and can therefore present a risk of bacterial transmission to patients. Antimicrobial prophylaxis is warranted for the duration of leech therapy, however, an institutional evaluation of 40 patients receiving medicinal leech therapy demonstrated poor adherence with recommendations. An electronic medical record order panel for antimicrobial prophylaxis with medicinal leech therapy was implemented, leading to a subsequent improvement in adherence to prophylaxis use, including significant increases in the ordering of antibiotics and the appropriate timing of initiation in the subsequent 10 patients receiving medicinal leech therapy after panel implementation. Aeromonas infections were rare before and after panel implementation, and developed only in the patient subset with non-optimized prophylaxis.

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.578 ◽

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

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Financial Impact of Tertiary Care in an Academic Medical Center

Annals of Surgery ◽

10.1097/00000658-200006000-00010 ◽

2000 ◽

Vol 231 (6) ◽

pp. 860-868 ◽

Cited By ~ 16

Author(s):

Thomas S. Huber ◽

Lori M. Carlton ◽

Donna G. O’Hern ◽

Nancy S. Hardt ◽

C. Keith Ozaki ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Financial Impact ◽

Academic Medical

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421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.621 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S311-S311

Author(s):

Laura Selby ◽

Richard Starlin

Keyword(s):

Healthcare Workers ◽

Screening Program ◽

Medical Center ◽

Severe Disease ◽

Academic Medical Center ◽

Tertiary Care ◽

Limited Data ◽

Viral Shedding ◽

Academic Medical ◽

Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

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

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2018.15.31 ◽

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.

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A preliminary investigation of opinions and behaviors regarding advance directives for medical care

American Journal of Critical Care ◽

10.4037/ajcc1993.2.2.161 ◽

1993 ◽

Vol 2 (2) ◽

pp. 161-167 ◽

Cited By ~ 37

Author(s):

EH Elpern ◽

SB Yellen ◽

LA Burton

Keyword(s):

Advance Directives ◽

Advance Directive ◽

Medical Center ◽

Academic Medical Center ◽

Preliminary Investigation ◽

Tertiary Care ◽

Living Will ◽

Treatment Preferences ◽

Convenience Sample ◽

And Behaviors

BACKGROUND: Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. METHODS: A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. RESULTS: Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. CONCLUSIONS: Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.

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