An assessment of transesophageal echocardiography studies rated as rarely appropriate tests for infective endocarditis at an academic medical center

2019 ◽  
Vol 36 (11) ◽  
pp. 2070-2077 ◽  
Author(s):  
Tomas Amuchastegui ◽  
David J. Hur ◽  
Nicole M. Lynn Fillipon ◽  
Maxwell D. Eder ◽  
Jason A. Bonomo ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

scholarly journals 1026. Trends in Infective Endocarditis During the Substance Use Disorder Epidemic at an Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S306-S306 ◽  
Author(s):  
Craig A Martin ◽  
Donna R Burgess ◽  
Katie L Wallace ◽  
Jeremy Vanhoose ◽  
Sarah Cotner ◽  
...  
Keyword(s):  
Substance Use ◽  
Infective Endocarditis ◽  
Substance Use Disorders ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Opioid Overdose ◽  
Academic Medical ◽  
The Mean ◽  
Overdose Deaths

Abstract Background In many areas of the United States, substance use disorders (SUD) have increased dramatically over the past decade. Overdose deaths have increased as well, and Kentucky ranks among the nation’s leaders in deaths per 100,000 population. Infective endocarditis (IE) is a well-known complication of intravenous drug use, contributing to significant morbidity and mortality, but few studies have evaluated the effect of the current SUD epidemic on rates and demographics of IE. We sought to examine the trends in IE and IE with SUD at our institution. Methods We collected data from patients admitted to a large academic medical center in Kentucky between January 1, 2013 and December 31, 2016. Patients were classified according to the International Classification of Diseases, Tenth Revision. Patients were considered to have IE if they received codes I33 or I38. Patients were considered to have an SUD if they received codes F11.10, F15.10, F14.10, F19.10, or Z86.59. Data were collected through the TriNetX database (TriNetX, Cambridge, MA). Results There were 2,100 cases of IE during the study period. The mean (SD) age was 53 years (21). Of those, 440 also had an SUD. The mean (SD) age of these patients was 41 years (11). Patients in both the IE and IE/SUD categories were primarily male (54% and 55%) and white (94% and 94%). The number of cases of IE increased from 190 in 2013 to 430 in 2016 (R2 = 0.9877). The number of IE cases diagnosed as having an SUD increased from 30 (16% of all IE cases) in 2013 to 130 (30% of all IE cases) in 2016 (R2 = 0.7352 for the trend). This increase in cases corresponds to a 333% increase in the number of cases of IE with SUD. Conclusion Between 2014 and 2016, opioid overdose deaths in Kentucky rose from 24.7 to 33.5 per 100,000 population, a 35.6% increase. During a similar timeframe, the number of IE cases associated with SUD at our institution rose 333%. While it is possible that increased coding of substance use disorders factored into this dramatic increase, it appears that the number of IE cases associated with SUD is rising at a disproportionately rapid rate. Disclosures All authors: No reported disclosures.

Utilization of Real-time 3D Transesophageal Echocardiography in an Urban Academic Medical Center

2014 ◽  
Vol 5 (2) ◽  
pp. 9-14
Author(s):  
Lili Zhang ◽  
Elaine Y Lin ◽  
Dron Bhandari ◽  
Mohan Pamerla ◽  
George K Lui ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Real Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
3D Transesophageal Echocardiography

scholarly journals 140. Trends of Infective Endocarditis at a Northern New England Academic Medical Center, From 2011 to 2017: A Case for Improved Methods to Reliably Identify Associated Substance Use

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S98-S98
Author(s):  
Martha T DesBiens ◽  
David de Gijsel ◽  
Benjamin P Chan ◽  
Elizabeth A Talbot ◽  
Stephen Conn ◽  
...  
Keyword(s):  
Substance Use ◽  
Infective Endocarditis ◽  
New England ◽  
Disease Burden ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Discharge Diagnosis ◽  
Composite Measure ◽  
Academic Medical

Abstract Background Infective endocarditis (IE) is a morbid and often lethal complication of injection drug use. There is an urgent need for accurate surveillance for IE related to substance use (SU) to support control strategies. Methods We conducted a retrospective comparative analysis of 3 datasets evaluating patients aged ≥16 years admitted to an academic medical center in New England with an ICD-9/10 discharge diagnosis of IE from April 2011 to December 2017. The 3 datasets included the hospital’s electronic medical record (EMR); the hospital’s Outpatient Parenteral Antibiotic Therapy (OPAT) program dataset; and the New Hampshire Uniform Hospital Discharge Data Set (UHDDS). We analyzed the number of admissions for IE per year, stratified by SU. We developed a SU composite measure by incorporating multiple sources of data from the EMR, and then verified accuracy of both the SU and IE diagnoses through manual chart review. Results The EMR documented 472 hospital admissions for IE, representing 385 unique patients. The median age was 56 years and 59% were men. Admissions increased 67%, from 56 in 2012 to 84 in 2017. SU was coded as a discharge diagnosis in 27% of these admissions; however, based on our composite measure of SU, 45% IE admissions were possibly associated with SU. The proportion of IE patients who had evidence of SU increased from 20% in 2011 to 49% in 2017 (P = 0.002). Patients with SU compared with those without were younger (40.5 vs. 65.2 years, P < 0.001) and more likely to be on Medicaid (59% vs. 8%, P < 0.001). They had higher average charges ($146,633 vs. $107,223, P = 0.002) and lengths of stay (19.1 vs. 13.4 days, P < 0.001). The UHDDS and EMR datasets identified a similar numbers of patients with a diagnosis of IE; however, manual chart review revealed that IE was over-coded in ~one-fifth of admissions. Conclusion The rate of IE in our hospital increased dramatically between 2011 and 2017, with a rising proportion associated with SU. Despite these trends, we found that discharge diagnosis coding alone substantially underestimated associated SU and overestimated IE disease burden. Our findings suggest public health administrative datasets, such as the UHDDS, can contribute to surveillance of IE disease burden with consideration of these important limitations, especially for assessing disease trends. Disclosures All authors: No reported disclosures.

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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