Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center

Introduction: The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In response, we created multi-disciplinary evidence-based guidelines to standardize the care for obstetric patients presenting with flank pain and suspicion for nephrolithiasis.Methods: A multi-disciplinary team involving Urology, Obstetric Anesthesiology, Obstetrics and Gynecology, Diagnostic Radiology, and Interventional Radiology from a single academic medical center was assembled. A PubMed search was performed using keywords of pregnancy/antepartum, nephrolithiasis/calculi/kidney stones, ureteroscopy, non-obstetric surgery, complications, preterm delivery, MRI, computerized tomography, renal bladder ultrasound (RBUS), and anesthesia to identify relevant articles. Team members reviewed their respective areas to create a comprehensive set of guidelines. One invited external expert reviewed the guidelines for validation purposes.Results: A total of 54 articles were reviewed for evidence synthesis. Four guideline statements were constructed to guide diagnosis and imaging, and seven statements to guide intervention. Guidelines were then used to create a diagnostic and intervention flowchart for ease of use. In summary, RBUS should be the initial diagnostic study. If diagnostic uncertainty still exists, a non-contrast CT scan should be obtained. For obstetric patients presenting with a septic obstructing stone, urgent decompression should be achieved. We recommend ureteral stent placement as the preferred intervention if local factors allow.Conclusions: We present a standardized care pathway for the management of nephrolithiasis during pregnancy. Our aim is to standardize and simplify the clinical management of these complex scenarios for urologists.

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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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164. Avoiding Complacency: Assessing the Perceived Impact and Value of Antimicrobial Stewardship at a Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.209 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S90-S91

Author(s):

Matthew S Lee ◽

Christopher McCoy

Keyword(s):

Antimicrobial Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Clinical Decision ◽

Team Members ◽

Academic Medical ◽

Support Tools ◽

Educational Engagement ◽

Similar Survey ◽

Perceived Impact

Abstract Background Multi-disciplinary engagement and education remain key measures for Antimicrobial Stewardship Programs (ASPs). Over 3 years, our ASP has undergone key changes to pre-authorization review, post-prescriptive activities, and core team members, coinciding with a 30% increase in stewardship interventions. The objectives of this study were to evaluate the familiarity of Nursing, Pharmacy and Prescribers at our academic medical center regarding ASP activities and services, as well as perceived impact on patient care and value. Secondary objectives were to determine what resources are currently utilized and areas for improvement. Methods Distinct surveys were distributed to three participant groups: Nurses, Pharmacists, and Prescribers (Housestaff, Advanced Practice Providers, and staff physicians). Questions were developed to assess familiarity, perceived value, and overall satisfaction with the ASP. Additional items included questions on the current use of ASP resources and educational engagement. Survey results were compared to a similar survey conducted 3 years amongst the same participant groups. Results The survey was delivered electronically to 3367 Prescribers, Nurses and Pharmacists. 403 responders completed the survey (208 Nurses, 181 Prescribers, and 18 Pharmacists). Familiarity was lowest amongst Nurses, but almost doubled compared to 2016 (Figure). Prescribers cited “restricted antibiotic approval”, “de-escalation”, and “alternative therapies relative to allergies” as the three most common interaction types, similar to 2016. ASP interactions continued to be rated “moderate” or “high” value (88.4% vs 89.15% in 2016), however, face-to-face interactions were preferred by only 4% of responders (unchanged compared to 2016). Prescribers also responded uncommon use of ASP online resources (20%) and clinical decision support tools (34%). 78% of responders expressed desire for increased ASP-related education. Conclusion As ASPs evolve, it is important to constantly evaluate impact and value, and identify areas for growth. Despite ASP familiarity being high and interactions valued, we need to further optimize ASP provided resources, clinical support tools, and educational offerings. Disclosures All Authors: No reported disclosures

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Implementation of a pharmacist-provided pharmacogenomics service in an executive health program

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab137 ◽

2021 ◽

Author(s):

Ina Liko ◽

Lisa Corbin ◽

Eric Tobin ◽

Christina L Aquilante ◽

Yee Ming Lee

Keyword(s):

Health Program ◽

Medical Center ◽

Academic Medical Center ◽

Test Results ◽

Sample Collection ◽

Team Members ◽

University Of Colorado ◽

Academic Medical ◽

Previous Medication ◽

Selection Of

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center. Summary As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient’s current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement. Conclusion The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.

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Supporting researchers through full-service hotline and consultation services: Success in simplicity, customization, and staffing

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.428 ◽

2020 ◽

Vol 4 (1) ◽

pp. 3-7

Author(s):

Rebecca Namenek Brouwer ◽

Emily Miller ◽

Sunita Patil ◽

Geeta K. Swamy ◽

Rebbecca Moen ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Team Members ◽

School Of Medicine ◽

Academic Medical ◽

High Satisfaction ◽

Duke University ◽

Research Questions ◽

New Research ◽

Consultation Services

AbstractNavigating the research domain at an academic medical center can be challenging, even for seasoned investigators. To address this, Duke University launched two initiatives: (1) a research navigation “hotline” to provide brief assistance with a variety of research questions; and (2) researcher onboarding and consultation, a one-to-one tailored offering to ensure that researchers are equipped to navigate research resources and processes effectively. The services are provided by the myRESEARCHnavigators (MRN) team, funded by Duke’s CTSA. The diverse scientific backgrounds of the six team members align well with those of the research community, allowing for a good match between the researcher and MRN team member. The MRN team answers approximately 30 questions per month, and has provided consultations to almost 400 researchers. Both services receive high satisfaction ratings (4 or 5 stars [out of 5 stars] given to 90% of hotline answers, and 99% of researcher onboarding/consultation sessions). As of July 2019, the School of Medicine has determined that the consultations are critical to their mission and have made them a requirement for new research faculty. The team will continue marketing both services to encourage adoption.

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Interns' Experiences of Disruptive Behavior in an Academic Medical Center

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00025.1 ◽

2013 ◽

Vol 5 (1) ◽

pp. 25-30 ◽

Cited By ~ 16

Author(s):

Charles P. Mullan ◽

Jo Shapiro ◽

Graham T. McMahon

Keyword(s):

Disruptive Behavior ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Environment ◽

First Year ◽

Convenience Sample ◽

Team Members ◽

Academic Medical ◽

And Gender ◽

Attending Physicians

Abstract Background The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice. Objective To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment. Method All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated. Results A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P = .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P < .001), exclusion from decision making (OR, 6.97; P < .001), and berating (OR, 4.84; P = .02). Inappropriate jokes, abusive language, and gender bias were also reported, and they were not significantly more frequent among interns than attending physicians. Interns most frequently identified nurses as the source of disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P < .001). Attendings reported other physicians as the most frequent source of disruption. Conclusions Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.

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Orientation Program for Hospital-Based Nurse Practitioners

AACN Advanced Critical Care ◽

10.4037/15597768-2009-1010 ◽

2009 ◽

Vol 20 (1) ◽

pp. 82-90

Author(s):

Mona N. Bahouth ◽

Mary Beth Esposito-Herr

Keyword(s):

Nurse Practitioners ◽

Medical Center ◽

Academic Medical Center ◽

Orientation Program ◽

Team Members ◽

University Of Maryland ◽

Academic Medical ◽

Key Variables ◽

Preceptor Programs ◽

The University

The transition from student to practicing clinician is often a challenging and difficult period for many nurse practitioners. Newly graduated nurse practitioners commonly describe feelings of inadequacy in assuming clinical responsibilities, lack of support by team members, unclear expectations for the orientation period, and role isolation. This article describes the formal nurse practitioner orientation program implemented at the University of Maryland Medical Center, a large urban academic medical center, to facilitate the transition of new nurse practitioners into the workforce. This comprehensive program incorporates streamlined administrative activities, baseline didactic and simulation-based critical care education, ongoing and focused peer support, access to formalized resources, and individualized clinical preceptor programs. This formalized orientation program has proven to be one of the key variables to successful integration of nurse practitioners into our acute care clinical teams.

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A Multidisciplinary Care Pathway Significantly Increases the Number of Early Morning Discharges in a Large Academic Medical Center

Quality Management in Health Care ◽

10.1097/qmh.0000000000000049 ◽

2015 ◽

Vol 24 (1) ◽

pp. 45-51 ◽

Cited By ~ 7

Author(s):

Raghu Durvasula ◽

Arkan Kayihan ◽

Sherri Del Bene ◽

Marion Granich ◽

Grace Parker ◽

...

Keyword(s):

Care Pathway ◽

Medical Center ◽

Academic Medical Center ◽

Multidisciplinary Care ◽

Early Morning ◽

Academic Medical

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Inpatient portal clusters: identifying user groups based on portal features

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocy147 ◽

2018 ◽

Vol 26 (1) ◽

pp. 28-36 ◽

Cited By ~ 8

Author(s):

Naleef Fareed ◽

Daniel Walker ◽

Cynthia J Sieck ◽

Robert Taylor ◽

Seth Scarborough ◽

...

Keyword(s):

Clustering Algorithm ◽

Medical Center ◽

Academic Medical Center ◽

Future Research ◽

Team Members ◽

Patient Admissions ◽

Log Files ◽

Academic Medical ◽

User Groups ◽

Post Hoc

Abstract Objective Conduct a cluster analysis of inpatient portal (IPP) users from an academic medical center to improve understanding of who uses these portals and how. Methods We used 18 months of data from audit log files, which recorded IPP user actions, of 2815 patient admissions. A hierarchical clustering algorithm was executed to group patient admissions on the basis of proportion of use for each of 10 IPP features. Post-hoc analyses were conducted to further understand IPP use. Results Five cluster solutions were developed for the study sample. Our taxonomy included users with high levels of accessing features that were linked to reviewing schedules, results, tutorials, and ordering food. Patients tended to stay within their clusters over multiple admissions, and the clusters had differences based on patient and clinical characteristics. Discussion Distinct groups of users exist among IPP users, suggesting that training on IPP use to enhance patient engagement could be tailored to patients. More exploration is also needed to understand why certain features were not used across all clusters. Conclusions It is important to understand the specifics about how patients use IPPs to help them better engage with their healthcare. Our taxonomy enabled characterization of 5 groups of IPP users who demonstrated distinct preferences. These results may inform targeted improvements to IPP tools, could provide insights to improve patient training around portal use, and may help care team members effectively engage patients in the use of IPPs. We also discuss the implications of our findings for future research.

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