Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

2013 ◽  
Vol 04 (05) ◽  
Author(s):  
Wei Xue Zhe Yan ◽  
Rebecca Barnett Lee Fleisher
Keyword(s):  
Elective Case ◽  
Academic Center

scholarly journals Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes

2021 ◽  
Vol 9 (1) ◽  
pp. e001557
Author(s):  
Ariana Pichardo-Lowden ◽  
Guillermo Umpierrez ◽  
Erik B Lehman ◽  
Matthew D Bolton ◽  
Christopher J DeFlitch ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Stress Hyperglycemia ◽  
Inappropriate Use ◽  
Academic Center

IntroductionInnovative approaches are needed to design robust clinical decision support (CDS) to optimize hospital glycemic management. We piloted an electronic medical record (EMR), evidence-based algorithmic CDS tool in an academic center to alert clinicians in real time about gaps in care related to inpatient glucose control and insulin utilization, and to provide management recommendations.Research design and methodsThe tool was designed to identify clinical situations in need for action: (1) severe or recurrent hyperglycemia in patients with diabetes: blood glucose (BG) ≥13.88 mmol/L (250 mg/dL) at least once or BG ≥10.0 mmol/L (180 mg/dL) at least twice, respectively; (2) recurrent hyperglycemia in patients with stress hyperglycemia: BG ≥10.0 mmol/L (180 mg/dL) at least twice; (3) impending or established hypoglycemia: BG 3.9–4.4 mmol/L (70–80 mg/dL) or ≤3.9 mmol/L (70 mg/dL); and (4) inappropriate sliding scale insulin (SSI) monotherapy in recurrent hyperglycemia, or anytime in patients with type 1 diabetes. The EMR CDS was active (ON) for 6 months for all adult hospital patients and inactive (OFF) for 6 months. We prospectively identified and compared gaps in care between ON and OFF periods.ResultsWhen active, the hospital CDS tool significantly reduced events of recurrent hyperglycemia in patients with type 1 and type 2 diabetes (3342 vs 3701, OR=0.88, p=0.050) and in patients with stress hyperglycemia (288 vs 506, OR=0.60, p<0.001). Hypoglycemia or impending hypoglycemia (1548 vs 1349, OR=1.15, p=0.050) were unrelated to the CDS tool on subsequent analysis. Inappropriate use of SSI monotherapy in type 1 diabetes (10 vs 22, OR=0.36, p=0.073), inappropriate use of SSI monotherapy in type 2 diabetes (2519 vs 2748, OR=0.97, p=0.632), and in stress hyperglycemia subjects (1617 vs 1488, OR=1.30, p<0.001) were recognized.ConclusionEMR CDS was successful in reducing hyperglycemic events among hospitalized patients with dysglycemia and diabetes, and inappropriate insulin use in patients with type 1 diabetes.

scholarly journals Impact of COVID-19 Vaccine Administration on Radiology Department Workflow: A Single Academic Center Experience

2021 ◽  
Author(s):  
Kaushik Chagarlamudi ◽  
Amy Rutledge ◽  
Victoria Uram ◽  
Elias G. Kikano ◽  
Sree H. Tirumani ◽  
...  
Keyword(s):  
Radiology Department ◽  
Vaccine Administration ◽  
Academic Center

scholarly journals Local Experience with a New Retrievable Device for Stroke Thrombectomy in a Tertiary Academic Center

2017 ◽  
Author(s):  
Mohammed Almekhlafi ◽  
Dareen Alshaer ◽  
Abdulelah Alturkistani ◽  
Abeer Khoja ◽  
O Ayub
Keyword(s):  
Academic Center ◽  
Local Experience

scholarly journals Blood usage at a large academic center in Maryland in relation to the COVID ‐19 pandemic in 2020

Transfusion ◽  
2021 ◽  
Author(s):  
Colin Murphy ◽  
Magali Fontaine ◽  
Paul Luethy ◽  
Heather McGann ◽  
Bryon Jackson
Keyword(s):  
Academic Center ◽  
Blood Usage

scholarly journals Ex-vivo forces associated with intrauterine device placement and perforation: a biomechanical evaluation of hysterectomy specimens

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jane Duncan ◽  
Kathryn Fay ◽  
Jessica Sanders ◽  
Benjamin Cappiello ◽  
Jane Saviers-Steiger ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Intrauterine Device ◽  
Compressive Force ◽  
Premenopausal Women ◽  
Biomechanical Analysis ◽  
Uterine Perforation ◽  
Ex Vivo Model ◽  
Single Observation ◽  
Academic Center ◽  
Device Placement

Abstract Background This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound. Methods We obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers’ placement instruments for two commercially available products and a metal sound. Results Sixteen individuals provided hysterectomy specimens. No complete perforations occurred while using loaded intrauterine devices; in a single observation the LNG IUS entered the myometrium. The plastic intrauterine device placement rod bowed in all attempts and did not perforate the uterine serosa at the fundus. A metal uterine sound created a complete perforation in all specimens (p < .001). The lowest mean maximum force generated occurred with the levonorgestrel intrauterine system placement instrument 12.3 N (SD ± 3.8 N), followed by the copper T380A intrauterine device placement instrument 14.1 N (SD ± 4.0 N), and highest for the metal sound 17.9 N (SD ± 7.6 N) (p < 0.01). Conclusions In this ex-vivo model, metal uterine sounds caused complete perforation and intrauterine device placement instruments did not. This study received Institutional Review Board (IRB0059096) approval.

scholarly journals MRI-based radiomic feature analysis of end-stage liver disease for severity stratification

2021 ◽  
Author(s):  
Jennifer Nitsch ◽  
Jordan Sack ◽  
Michael W. Halle ◽  
Jan H. Moltz ◽  
April Wall ◽  
...  
Keyword(s):  
Disease Severity ◽  
Prediction Models ◽  
Blood Parameters ◽  
Meld Score ◽  
Poor Correlation ◽  
Discrimination Ability ◽  
Random Forest Classification ◽  
Forest Classification ◽  
Academic Center ◽  
End Stage

Abstract Purpose We aimed to develop a predictive model of disease severity for cirrhosis using MRI-derived radiomic features of the liver and spleen and compared it to the existing disease severity metrics of MELD score and clinical decompensation. The MELD score is compiled solely by blood parameters, and so far, it was not investigated if extracted image-based features have the potential to reflect severity to potentially complement the calculated score. Methods This was a retrospective study of eligible patients with cirrhosis ($$n=90$$ n = 90 ) who underwent a contrast-enhanced MR screening protocol for hepatocellular carcinoma (HCC) screening at a tertiary academic center from 2015 to 2018. Radiomic feature analyses were used to train four prediction models for assessing the patient’s condition at time of scan: MELD score, MELD score $$\ge $$ ≥ 9 (median score of the cohort), MELD score $$\ge $$ ≥ 15 (the inflection between the risk and benefit of transplant), and clinical decompensation. Liver and spleen segmentations were used for feature extraction, followed by cross-validated random forest classification. Results Radiomic features of the liver and spleen were most predictive of clinical decompensation (AUC 0.84), which the MELD score could predict with an AUC of 0.78. Using liver or spleen features alone had slightly lower discrimination ability (AUC of 0.82 for liver and AUC of 0.78 for spleen features only), although this was not statistically significant on our cohort. When radiomic prediction models were trained to predict continuous MELD scores, there was poor correlation. When stratifying risk by splitting our cohort at the median MELD 9 or at MELD 15, our models achieved AUCs of 0.78 or 0.66, respectively. Conclusions We demonstrated that MRI-based radiomic features of the liver and spleen have the potential to predict the severity of liver cirrhosis, using decompensation or MELD status as imperfect surrogate measures for disease severity.

scholarly journals Anastomotic Ulcers After Ileocolic Resection for Crohn’s Disease Are Common and Predict Recurrence

2019 ◽  
Vol 26 (7) ◽  
pp. 1050-1058 ◽  
Author(s):  
Robert P Hirten ◽  
Ryan C Ungaro ◽  
Daniel Castaneda ◽  
Sarah Lopatin ◽  
Bruce E Sands ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Multivariable Analysis ◽  
Disease Recurrence ◽  
Ileocolic Resection ◽  
Anastomotic Ulcer ◽  
Endoscopic Recurrence ◽  
Academic Center ◽  
Endoscopic Remission ◽  
The Impact

Abstract Background Crohn’s disease recurrence after ileocolic resection is common and graded with the Rutgeerts score. There is controversy whether anastomotic ulcers represent disease recurrence and should be included in the grading system. The aim of this study was to determine the impact of anastomotic ulcers on Crohn’s disease recurrence in patients with prior ileocolic resections. Secondary aims included defining the prevalence of anastomotic ulcers, risk factors for development, and their natural history. Methods We conducted a retrospective cohort study of patients undergoing an ileocolic resection between 2008 and 2017 at a large academic center, with a postoperative colonoscopy assessing the neoterminal ileum and ileocolic anastomosis. The primary outcome was disease recurrence defined as endoscopic recurrence (&gt;5 ulcers in the neoterminal ileum) or need for another ileocolic resection among patients with or without an anastomotic ulcer in endoscopic remission. Results One hundred eighty-two subjects with Crohn’s disease and an ileocolic resection were included. Anastomotic ulcers were present in 95 (52.2%) subjects. No factors were associated with anastomotic ulcer development. One hundred eleven patients were in endoscopic remission on the first postoperative colonoscopy. On multivariable analysis, anastomotic ulcers were associated with disease recurrence (adjusted hazard ratio [aHR] 3.64; 95% CI, 1.21–10.95; P = 0.02). Sixty-six subjects with anastomotic ulcers underwent a second colonoscopy, with 31 patients (79.5%) having persistent ulcers independent of medication escalation. Conclusion Anastomotic ulcers occur in over half of Crohn’s disease patients after ileocolic resection. No factors are associated with their development. They are associated with Crohn’s disease recurrence and are persistent.

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