scholarly journals Increasing Burden of Methicillin-Resistant Staphylococcus aureus Hospitalizations at US Academic Medical Centers, 2003–2008

2012 ◽  
Vol 33 (8) ◽  
pp. 782-789 ◽  
Author(s):  
Michael Z. David ◽  
Sofia Medvedev ◽  
Samuel F. Hohmann ◽  
Bernard Ewigman ◽  
Robert S. Daum
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Medical Center ◽  
Academic Medical Centers ◽  
University Of Chicago ◽  
Medical Centers ◽  
Academic Medical ◽  
The University ◽  
Chicago Medical

Objective.The incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States decreased during 2005–2008, but noninvasive community-associated MRSA (CA-MRSA) infections also frequently lead to hospitalization. We estimated the incidence of all MRSA infections among inpatients at US academic medical centers (AMCs) per 1,000 admissions during 2003–2008.Design.Retrospective cohort study.Setting and Participants.Hospitalized patients at 90% of nonprofit US AMCs during 2003–2008.Methods.Administrative data on MRSA infections from a hospital discharge database (University HealthSystem Consortium [UHC]) were adjusted for underreporting of the MRSA V09.0 International Classification of Diseases, Ninth Revision, Clinical Modification code and validated using chart reviews for patients with known MRSA infections in 2004–2005, 2006, and 2007.Results.The mean sensitivity of administrative data for MRSA infections at the University of Chicago Medical Center in three 12-month periods during 2004–2007 was 59.1%. On the basis of estimates of billing data sensitivity from the literature and the University of Chicago Medical Center, the number of MRSA infections per 1,000 hospital discharges at US AMCs increased from 20.9 (range, 11.1–47.7) in 2003 to 41.7 (range, 21.9–94.0) in 2008. At the University of Chicago Medical Center, among infections cultured more than 3 days prior to hospital discharge, CA-MRSA infections were more likely to be captured in the UHC billing-derived data than were healthcare-associated MRSA infections.Conclusions.The number of hospital admissions for any MRSA infection per 1,000 hospital admissions overall increased during 2003–2008. Use of unadjusted administrative hospital discharge data or surveillance for invasive disease far underestimates the number of MRSA infections among hospitalized patients.

Can Pediatric Training Manage in Managed Care?

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. 1143-1145
Author(s):  
Laurel K. Leslie
Keyword(s):  
Managed Care ◽  
San Francisco ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Of California ◽  
Academic Medical Centers ◽  
Full Time ◽  
Medical Centers ◽  
Academic Medical ◽  
The University

On January 18, 1995, the University of California convened a special meeting to discuss the business operations of its five academic medical centers in San Francisco, Sacramento, San Diego, Los Angeles, and Irvine. Because of the rapid developments occurring in the maturing and competitive managed care market in California, the academic medical centers are facing unprecedented financial pressures. Charles Townsend, of the accounting firm KPMG Peat Marwick, stated that the medical centers' staff would need to be cut by at least 2500 full-time equivalents, including physicians and nurses, by the year 1999. William Kerr, Director of the University of California San Francisco Medical Center, forecasted a comprehensive restructuring and streamlining of services. Jordan Cohen, president of the Association of American Medical Colleges, described the challenges facing these five academic medical centers and others like them as "truly seismic."1 The rise of managed care medical systems during the last 5 years has led many researchers to question whether the academic medical center will survive in its current state.2-6 Market forces are changing the provision of medical care at an extremely fast pace. By 1998, an estimated 60% of people living in US cities will be covered by managed care health plans. Fewer hospital admissions, shorter hospital stays, and decreased reimbursements associated with managed care have decreased hospitals' operating gains. Academic medical centers, such as those in California, are facing pressure to lower health care delivery costs. The probable decreases in Medicare and research funds under the current Congress also threaten the financial revenues of academic medical centers.

Issues in Developing the Medical Scientist, Part 1: Interview with Dr. Robert W. Schrier, MD

2004 ◽  
Vol 52 (4) ◽  
pp. 242-245
Keyword(s):  
Department Chair ◽  
Academic Medical Centers ◽  
Renal Diseases ◽  
Full Time ◽  
Institute Of Medicine ◽  
University Of Colorado ◽  
Medical Centers ◽  
Academic Medical ◽  
The University ◽  
Time Faculty

The American Federation for Medical Research (AFMR) will present a series of articles that address the challenges faced by academic medical centers and other institutions in developing medical scientists (see the accompanying introduction to the series on page 241). The goal of this series is to assist leaders at academic medical centers in addressing the challenges for training the next generation of health care investigators. In addition, we hope to educate junior investigators and trainees on the many issues that their facilitators and mentors face in developing adequate programs for training and career development.Our first part of this series is an interview with Robert W. Schrier, MD. Dr. Schrier is a professor of medicine and was chairman of the Department of Medicine at the University of Colorado School of Medicine for 26 years and head of the Division of Renal Diseases and Hypertension for 20 years. Dr. Schrier's research accomplishments are enormous. He has had continuous funding for 35 years and has authored over 800 scientific papers and edited 45 books in renal medicine, geriatrics, drug use, and kidney disease. He is an acknowledged leader in academic medicine, as evidenced by his election to the Institute of Medicine of the National Academy of Sciences and presidencies of the Association of American Physicians, the American Society of Nephrology, the National Kidney Foundation, and the International Society of Nephrology. Dr. Schrier is a master of the American College of Physicians and an honorary fellow of the Royal College of Physicians. In addition, he has received the highest awards of several national and international organizations.However, it is not only the personal accomplishments of Dr. Schrier that led to his selection to take part in this series. Although those personal accomplishments are incredible, his work as a department chair, division chief, and research mentor may be greater. During Dr. Schrier's 26 years as chair of the Department of Medicine at the University of Colorado, the full-time faculty increased from approximately 75 to 500. The annual research grants by the department's full-time faculty rose from approximately $3 to $100 million, including the faculties' contributions to the General Clinical Research and Cancer Centers. The housestaff and fellow training programs also became nationally prominent. Thirty endowed research chairs between $1.5 and $2.0 million each were established. Clearly, he is a visionary who can speak to the challenges facing the young medical scientists and their mentors today.Dr. Schrier's responses to a series of questions follow.

Emergency Physician Involvement in Hospital Preparedness: A National Survey of Academic Medical Centers

2020 ◽  
pp. 1-4
Author(s):  
Kevin M. Ryan ◽  
Sina Mostaghimi ◽  
Julianne Dugas ◽  
Eric Goralnick
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Emergency Preparedness ◽  
Response Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Academic Medical Centers ◽  
Medical Centers ◽  
Academic Medical

ABSTRACT Objectives: The aim of this study was to determine the involvement of emergency medicine physicians at academic medical centers across the United States as well as their background training, roles in the hospital, and compensation if applicable for time dedicated to preparedness. Methods: A structured survey was delivered by means of email to 109 Chairs of Emergency Medicine across the United States at academic medical centers. Unique email links were provided to track response rate and entered into REDCap database. Descriptive statistics were obtained, including roles in emergency preparedness, training, and compensation. Results: Forty-four of the 109 participants responded, resulting in a response rate of 40.4%. The majority held an administrative role in emergency preparedness. Formal training for the position (participants could select more than 1) included various avenues of education such as emergency medical services fellowship or in-person or online courses. Of the participants, most (93.18%) strongly agreed that it was important to have a physician with expertise in disaster medicine assisting with preparedness. Conclusions: The majority of responding academic medical center participants have taken an active role in hospital emergency preparedness. Education for the roles varied though, often consisted of courses from emergency management agencies. Volunteering their time for compensation was noted by 27.5%.

Methicillin-ResistantStaphylococcus AureusCarriage Among Patients After Hospital Discharge

2005 ◽  
Vol 26 (7) ◽  
pp. 629-633 ◽  
Author(s):  
Menno R. Vriens ◽  
Hetty E. M. Blok ◽  
Ada C. M. Gigengack-Baars ◽  
Ellen M. Mascini ◽  
Chris van der Werken ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Medical Center ◽  
Eradication Therapy ◽  
Infect Control Hosp ◽  
The University ◽  
Mrsa Colonization

AbstractBackground and Objective:At the University Medical Center Utrecht (UMCU), follow-up implies an inventory of risk factors and screening for MRSA colonization among all MRSA-positive patients for at least 6 months. If risk factors or positive cultures persist or re-emerge, longer follow-up is indicated and isolation at readmission. This study investigated how long MRSA-positive patients remained colonized after hospital discharge and which risk factors were important. Furthermore, the results of eradication therapy were evaluated.Design:All patients who were positive for MRSA at the UMCU between January 1991 and January 2001 were analyzed regarding carriage state, presence of risk factors for prolonged carriage ofStaphylococcus aureus, and eradication treatment.Results:A total of 135 patients were included in the study. The median follow-up time was 1.2 years. Eighteen percent of the patients were dismissed from follow-up 1 year after discharge. Only 5 patients were dismissed after 6 months. Among patients with no risk factors, eradication treatment was effective for 95% within 1 year. Among patients with persistent risk factors, treatment was effective for 89% within 2 years.Conclusions:Based on these findings, eradication therapy should be prescribed for all MRSA carriers, independent of the presence of risk factors. MRSA-positive patients should be evaluated for 6 months for the presence of risk factors and MRSA carriage. Screening for risk factors is important because intermittent MRSA carriage was found in a significant number of our patients. Patients with negative MRSA cultures and without risk factors for 12 months can be safely dismissed from follow-up. (Infect Control Hosp Epidemiol 2005;26:629-633)

Utilization of Laparoscopy in Colorectal Surgery for Cancer at Academic Medical Centers: Does Site of Surgery Affect Rate of Laparoscopy?

2011 ◽  
Vol 77 (10) ◽  
pp. 1300-1304 ◽  
Author(s):  
Joseph C. Carmichael ◽  
Hossein Masoomi ◽  
Steven Mills ◽  
Michael J. Stamos ◽  
Ninh T. Nguyen
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Laparoscopic Colorectal Surgery ◽  
Right Hemicolectomy ◽  
Academic Medical Centers ◽  
Sigmoid Colectomy ◽  
Colorectal Cancer Surgery ◽  
Medical Centers ◽  
Academic Medical ◽  
The University

Use of laparoscopy in colorectal cancer surgery is still limited. The aim of this study was to determine the rate of use of laparoscopic colorectal surgery for cancer at academic medical centers and to evaluate if the site of surgery influences the rate of use. Clinical data of patients who underwent laparoscopic or open colon and rectal resections for cancer from 2007 to 2009 were obtained from the University HealthSystem Consortium database. Data concerning rate of laparoscopy, length of stay, morbidity, and risk-adjusted mortality were obtained. During the 36-month study period, 22,780 operations were performed. The overall rate for use of laparoscopy was 14.8 per cent. Laparoscopy was most often used for total colectomy (22.6%), sigmoid colectomy (17.3%), cecectomy (17.1%), and right hemicolectomy (17.0%). Laparoscopy was most infrequently used for abdominoperineal resection (8.0%), transverse colectomy (10.0%), and left hemicolectomy (13.1%). Length of stay for laparoscopic colon and rectal procedures was 3.2 days shorter than for open surgery. Although the benefits of laparoscopic colorectal surgery for cancer have been demonstrated, the use of laparoscopy for colorectal resection remains under 20 per cent for colon cancer and under 10 per cent for rectal cancer. Further studies are needed to determine the factors limiting the use of laparoscopy in colorectal surgery.

Retrospective chart evaluation of hypercalcemia management in oncology patients at the University of Chicago Medical Center

2017 ◽  
Vol 25 (2) ◽  
pp. 317-325 ◽  
Author(s):  
Kelly Plach ◽  
Randall W. Knoebel ◽  
Rita Nanda ◽  
Katherine Shea
Keyword(s):  
Primary Outcome ◽  
Medical Center ◽  
Fluid Management ◽  
Evidence Based ◽  
University Of Chicago ◽  
Hypercalcemia Of Malignancy ◽  
Primary Literature ◽  
The University ◽  
Chicago Medical ◽  
Single Center Observational Study

Introduction Due to the lack of formal guideline recommendations, available primary literature was used to develop a proposed protocol for management of hypercalcemia of malignancy at the University of Chicago Medical Center. Methods A retrospective, single center, observational study was performed including adult patients hospitalized with a diagnosis of hypercalcemia and active malignancy. Patients were retrospectively identified as treated in a manner aligned with the proposed protocol (“per protocol”) or not treated according to the proposed protocol (“off protocol”), and the outcomes were compared. The primary outcome for efficacy was normalization of corrected calcium within four and seven days of treatment. Results Normalization of corrected calcium was observed in 66% of patients managed per protocol compared to 65% of patients managed off protocol ( p = 1.00) at day four, and in 73% of per protocol patients compared to 65% of off protocol patients ( p = 0.44) at day seven. Areas identified where prospective implementation of the proposed protocol can improve management include: decreasing utilization of bisphosphonates in mild hypercalcemia, optimizing bisphosphonate dosing in renal impairment, decreasing intravenous phosphate repletion, and ensuring proper fluid management and calcitonin dosing. Conclusion Although a statistical difference was not detected in terms of normalization of corrected calcium levels, areas for optimization in management were identified. Therefore, implementation of the proposed protocol is expected to promote evidence-based management of hypercalcemia of malignancy management at University of Chicago Medical Center.

The Health of the Public Program at the University of Washington: A New Role for Academic Medical Centers

1991 ◽  
Vol 66 (9) ◽  
pp. 499-505 ◽  
Author(s):  
HAROLD I. GOLDBERG ◽  
DIANE P. MARTIN ◽  
DALE B. CHRISTENSEN ◽  
WILLIAM E. NEIGHBOR ◽  
THOMAS S. INUI ◽  
...  
Keyword(s):  
Academic Medical Centers ◽  
University Of Washington ◽  
The Public ◽  
Public Program ◽  
Medical Centers ◽  
Academic Medical ◽  
The University
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