OpenAthens odyssey: challenges of implementing federated authentication for a multi-institutional user population

Background: The Texas Medical Center (TMC) is home to one of the world’s largest cohorts of faculty, students, researchers, and clinicians who rely on seamless and immediate access to digital biomedical and health resources. This group is served by the TMC Library, with a collection that includes over 380,000 ebooks and 59,000 ejournals. In 2018, the TMC Library implemented OpenAthens, a federated authentication system to replace a locally hosted instance of EZproxy.Case Presentation: The TMC Library is unique in its multi-institutional user population, which presents distinct challenges in adopting a single sign-on authentication system. Our project involved OpenAthens technical support, information technology teams from six academic institutions, and over thirty publishers. Implementation included the creation of an OpenAthens parent account, an active user directory, a resource catalog, and installation of our OpenAthens credentials at each publisher site. Because the TMC Library serves multiple institutions, OpenAthens built a custom login page and a portal to support both single sign-on and a generic username and password option. This case report discusses the reasons why OpenAthens was chosen, the preparation methods for implementation, the various challenges encountered and resolved, and recommendations for other health sciences libraries considering this system.Conclusions: The OpenAthens system provides important benefits: granular usage reports, single sign-on access, and data to negotiate reduced pricing for online resources. With prior knowledge and preparation, health sciences libraries can successfully implement OpenAthens with customizations tailored to their specific resources and user population.

Practice What We Preach: Beginning a Journey to Embrace Patient-Centered Outcomes Research

Background: Patient-centered outcomes research seeks to answer patient-centered questions. The process includes varied locations and individuals throughout the care continuum to address individual differences and constraints in implementation and dissemination. Problem: This paper intends to answer this question: do academic nurses practice what they preach by assisting patient-centered outcomes research and researchers through their engagement with patients, caregivers, and other community stakeholder partners in nursing research? Approach: This paper provides an overview of how academic nurses in a single institution (the University of Texas Medical Branch at Galveston School of Nursing) began to embrace patient-centered outcomes research. Conclusion: Whether academic nurses are practicing what they preach in terms of patient-centered outcomes research remains uncertain. More examples from academia are required to make that determination. Academic nurses worldwide have embarked on a steep learning curve to embrace patient-centered outcomes research. This journey will require patience and a systematic strategy.

The history of neurosurgery at Baylor College of Medicine

The development of neurosurgery at Baylor College of Medicine began with the medical school’s relocation to the new Texas Medical Center in Houston in 1943. An academic service was organized in 1949 as a section of neurosurgery within Baylor’s Department of Surgery. Soon the practice, led by Dr. George Ehni, evolved to include clinical services at Methodist, Jefferson Davis (forerunner of Ben Taub), Texas Children’s, the Veterans Affairs, and the University of Texas MD Anderson Cancer Center hospitals. A neurosurgery residency program was established in 1954. As the clinical practice expanded, neurosurgery was upgraded from a section to a division and then to a department. It has been led by four chiefs/chairs over the past 60 years—Dr. George Ehni (1959–1979), Dr. Robert Grossman (1980–2004), Dr. Raymond Sawaya (2005–2014), and Dr. Daniel Yoshor (2015–2020). Since the 1950s, the department has drawn strength from its robust residency program, its research base in the medical school, and its five major hospital affiliates, which have largely remained unchanged (with the exception of Baylor St. Luke’s Medical Center replacing Methodist in 2004). The recent expansion of the residency program to 25 accredited positions and the growing strength of relationships with the “Baylor five” hospitals affiliated with Baylor College of Medicine portend a bright future.

44. Antibiotic Class-Based Distribution and Analysis of Reported Beta-Lactam Allergies amongst Hospitalized Patients

Background Reported β-lactam allergy (BLA) is very common, yet less than 10% of these patients exhibit true hypersensitivity. When faced with reported BLAs, physicians often choose alternative antibiotics which can be associated with C. difficile infection, drug-resistance development, poorer outcomes, & increased costs. Effective identification of these patients is necessary for subsequent, appropriate BLA “de-labeling.” Here, we conducted a single-center analysis of alternative antibiotic utilization amongst patients reporting BLA and compare the frequency of drug-resistant infections and C. difficile infection in allergic & non-allergic patients. Methods This is a retrospective review of adult patients hospitalized at The University of Texas Medical Branch from 1/1/2015 to 12/31/2019. Pooled electronic medical records were filtered by antibiotic orders and reported allergies to penicillins or cephalosporins. Patients with drug-resistant and/or C. difficile infection (CDI) were identified by ICD-10 codes. Microsoft Excel & MedCalc were used for statistical calculations. Results Data were available for 118,326 patients and 9.3% (11,982) reported a BLA, with the highest rates seen in those receiving aztreonam (85.9%, 530/617) & clindamycin (33.7%, 3949/11718). Amongst patients reporting BLA, high ratios-of-consumption (relative to all patients receiving antibiotics) were seen with aztreonam (7.0), clindamycin (2.7), cephalosporin/β-lactamase inhibitors (2.4), & daptomycin (2.1). Compared to the non-BLA population, BLA patients more frequently experienced MRSA infection (3.0% vs 1.5%, OR 1.99, 95% CI 1.79–2.23, p< 0.0001), β-lactam resistance (1.2% vs 0.6%, OR 2.07, 95% CI 1.72–2.49, p< 0.0001), and CDI (1.2% vs 0.7%, OR 1.85, 95% CI 1.54–2.23, p< 0.0001). Conclusion Our measured BLA rate matches approximate expectations near 10%. Moreover, these patients experienced significantly higher frequencies of drug-resistant bacterial infections and CDI. Targeted inpatient penicillin allergy testing stands to be particularly effective in those patients receiving disproportionately utilized alternative agents (e.g. aztreonam, clindamycin, daptomycin). β-lactam allergy “de-labeling” in these patients is likely a valuable antimicrobial stewardship target. Disclosures All Authors: No reported disclosures

Chester R. Burns (1937–2006) and the origins of the American Osler Society

The American Osler Society (AOS) traces its origin to a 1970 symposium on Humanism in Medicine in Galveston, Texas. Although John P. McGovern (1921–2007) receives credit for conceiving the symposium and spearheading formation of the AOS, Chester Ray Burns (1937–2006) played a key role that has not been sufficiently recognized. Burns, the first American-born physician to receive a doctorate in the history of medicine from the Johns Hopkins University, did much and perhaps most of the organizational work and brought to the symposium a perspective on the crossroads between medicine and the humanities that proved essential to the nascent organization’s success. Burns went on to a productive career at the University of Texas Medical Branch (UTMB) in Galveston, became the 35th president of the AOS, and is among the relatively few physician-historians to have published scholarly articles in the history of medicine, medical biography, medical ethics, and philosophy as related to medicine.

Houston: 1960–1969

As the 1960s begin, Baylor, Methodist Hospital, and the Texas Medical Center all undergo substantial growth. DeBakey begins his lifelong friendship with Princess Lilian of Belgium. Studies begin to elucidate the nature of atherosclerotic disease, while Cooley and DeBakey grow apart. President Lyndon B. Johnson appoints DeBakey to lead the Commission on Heart Disease, Cancer, and Stroke. DeBakey’s team performs early coronary artery bypass and an aortic aneurysm surgery on the Duke of Windsor. Accolades and publicity accrue for DeBakey. Work begins on artificial heart pumps. Heart transplants become a transient sensation. Restructuring of Baylor medical school results in DeBakey’s Presidency.

Bedside clinicians retain nurses through turnover analysis and best practices

The nursing shortage is projected to grow to well over 500,000 by 2020. Health care organizations are faced with increasing vacancies, mandating that strategic initiatives be developed to address the imperative of retaining their registered nurses (RNs). The implications for reducing RN turnover include improved safety and quality outcomes for patients. RN turnover also has financial implications. The average annual hospital cost of RN turnover is between $5.2 and $8.1 million dollars. Houston Methodist Hospital in the Texas Medical Center is a large, 1,200-bed metropolitan facility that employs over 3,000 nurses. By using shared governance to engage bedside clinicians and the ADKAR change model, nurse leaders were able to reduce organizational RN turnover from 16.39% to 10.57%, outperforming the national average and the American Nurses Credentialing Center’s benchmark for Magnet facilities with greater than or equal to 700 beds. This article will discuss the role of nurse leaders in creating a culture of retention, methods that were implemented at Houston Methodist Hospital to engage and empower beside clinicians to assume a lead role in reducing RN turnover, and the best practices discovered and implemented by bedside clinicians to improve RN turnover.

The Electronic Vesalius: Embodying Anatomy Atlases

A multidisciplinary team at Rice University transformed the Texas Medical Center (TMC) Library’s collection of rare anatomy atlases into a physical-digital, human-sized atlas-of-atlases. The Electronic Vesalius installation gives these old books new life, informed by contemporary media theory and the centuries of medical and aesthetic criticism provoked by these multimedia image-texts.