scholarly journals Prevalence of Low Plasma Vitamin B1 in the Stroke Population Admitted to Acute Inpatient Rehabilitation

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1034 ◽  
Author(s):  
Reza Ehsanian ◽  
Sean Anderson ◽  
Byron Schneider ◽  
David Kennedy ◽  
Vartgez Mansourian
Keyword(s):  
Thiamine Deficiency ◽  
Medical Center ◽  
Academic Medical Center ◽  
Vitamin B1 ◽  
Inpatient Rehabilitation ◽  
Plasma Vitamin ◽  
Stroke Service ◽  
Rehabilitation Facility ◽  
Stroke Population

Objective: To determine the prevalence of vitamin B1 (VitB1) deficiency in the stroke population admitted to acute inpatient rehabilitation. Design: Retrospective cohort study. Setting: Acute inpatient rehabilitation facility at an academic medical center. Participants: 119 consecutive stroke patients admitted to stroke service from 1 January 2018 to 31 December 2018. Interventions: Not applicable. Main Outcome Measures: Plasma VitB1 level. Results: There were 17 patients (14%; 95% CI 9–22%) with low VitB1 with a range of 2–3 nmol/L, an additional 58 (49%; CI 40–58%) patients had normal low VitB1 with a range of 4–9 nmol/L, twenty-five patients (21%; CI 15–29%) had normal high VitB1 with a range of 10–15 nmol/L, and nineteen patients (16%; CI 10–24%) had high VitB1 with a range of 16–43 nmol/L. Conclusions: In this cohort of patients admitted to the stroke service at an acute rehabilitation facility, there is evidence of thiamine deficiency. Moreover, the data suggest that there is inadequate acute intake of VitB1. Given the role of thiamine deficiency in neurologic function, further study of the role of thiamine optimization in the acute stroke rehabilitation population is warranted.

Role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center

2017 ◽  
Vol 74 (6) ◽  
pp. 417-423 ◽  
Author(s):  
Justin Siegfried ◽  
Cristian Merchan ◽  
Marco R. Scipione ◽  
John Papadopoulos ◽  
Arash Dabestani ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

Selective macrophage depletion in the liver does not prevent the development of the sick euthyroid syndrome in the mouse

1996 ◽  
Vol 134 (4) ◽  
pp. 513-518 ◽  
Author(s):  
Anita Boelen ◽  
Marianne C Platvoet-ter Schiphorst ◽  
Nico van Rooijen ◽  
Wilmar M Wiersinga
Keyword(s):  
Kupffer Cells ◽  
Medical Center ◽  
Academic Medical Center ◽  
Thyroid Hormone Metabolism ◽  
Macrophage Depletion ◽  
Liver Macrophages ◽  
Academic Medical ◽  
Selective Depletion ◽  
Sick Euthyroid

Boelen A, Platvoet-ter Schiphorst MC, van Rooijen N, Wiersinga WM. Selective macrophage depletion in the liver does not prevent the development of the sick euthyroid syndrome in the mouse. Eur J Endocrinol 1996;134:513–8. ISSN 0804–4643 A decreased serum triiodothyronine (T3) level is one of the main characteristics of the sick euthyroid syndrome, caused mainly by a decreased 5′-deiodination of thyroxine (T4) in the liver. Cytokines have been implicated in the pathogenesis of the changes in thyroid hormone metabolism during illness. We therefore investigated the role of cytokines produced by the liver macrophages (Kupffer cells) in the development of the sick euthyroid syndrome, which was induced in mice by a single injection of bacterial endotoxin (lipopolysaccharide) or by 24-h starvation. Experiments were carried out with or without previous selective depletion of liver macrophages by intravenous administration of liposome-encapsulated dichloromethylene diphosphonate. Relative to saline-injected pair-fed controls, the administration of lipopolysaccharide caused a decrease of serum T3 and T4 and liver 5′-deiodinase mRNA. Selective depletion of liver macrophages did not affect these changes. Starvation for 24 h decreased serum T3 and T4, associated with a slight decrease of liver 5′-deiodinase mRNA. There were no differences between macrophage-depleted and non-depleted animals in this respect. In summary, selective depletion of liver macrophages did not affect the decrease in serum T3, T4 or liver 5′-deiodinase mRNA induced by lipopolysaccharide or 24-h starvation in mice. We conclude that cytokines produced by Kupffer cells are not involved in the pathogenesis of the sick euthyroid syndrome in this experimental model. A Boelen, Department of Endocrinology, F5-171 Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

scholarly journals Fertility navigators in female oncofertility care in an academic medical center: a qualitative evaluation

2020 ◽  
Vol 28 (12) ◽  
pp. 5733-5741 ◽  
Author(s):  
M. van den Berg ◽  
S. Nadesapillai ◽  
D. D. M. Braat ◽  
R. P. M. G. Hermens ◽  
C. C. M. Beerendonk
Keyword(s):  
Fertility Preservation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Qualitative Evaluation ◽  
Added Value ◽  
Personal Care ◽  
Academic Medical ◽  
Supportive Role ◽  
Female Fertility Preservation

Abstract Purpose To explore patients’ and professionals’ experiences with fertility navigators in female oncofertility care. Methods Semi-structured in-depth interviews were conducted with nine female cancer patients and six healthcare professionals to explore their experiences. They were recruited from an academic medical center (referral clinic for female fertility preservation care). Data were analyzed using the concepts of grounded theory. Results Patients were satisfied about the supportive role of the fertility navigator in their fertility preservation process: fertility navigators added value as they became “familiar faces” and provided information, emotional support, personal care, and served as patients’ primary contact person. The fertility navigators had a pleasant collaboration with professionals and supported professionals by taking over tasks. To improve the role of fertility navigators, it was suggested that they should always be present in fertility preservation counseling, and attention should be paid to their availability to improve continuity of care. Conclusion Fertility navigators provide personal care, improve satisfaction in patients in their oncofertility process, and support professionals. The overview of issues that need to be addressed when assigning fertility navigators in female oncofertility care combined with the improvement suggestions could be used by other centers when considering implementing fertility navigators.

Physical Function in the Hospital Is Associated With Patient-Centered Outcomes in an Inpatient Rehabilitation Facility

2020 ◽  
Vol 100 (8) ◽  
pp. 1237-1248 ◽  
Author(s):  
Joshua K Johnson ◽  
Julie M Fritz ◽  
Benjamin S Brooke ◽  
Paul C LaStayo ◽  
Anne Thackeray ◽  
...  
Keyword(s):  
Physical Function ◽  
Hospital Discharge ◽  
Short Form ◽  
Academic Medical Center ◽  
Inpatient Rehabilitation ◽  
Acute Hospital ◽  
Adjusted Relative Risk ◽  
Day Hospital ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

Abstract Objective Poor knowledge of the relationships between physical function (PF) in the hospital and patient outcomes in an inpatient rehabilitation facility (IRF) limits the identification of patients most appropriate for discharge to an IRF. This study aimed to test for independent associations between PF measured via the AM-PAC “6-clicks” basic mobility short form in the hospital and outcomes in an IRF. Methods This was a retrospective cohort study. Primary data were collected from an acute hospital and IRF at 1 academic medical center. Associations were tested between PF at hospital admission or discharge and PF improvement in the IRF, discharge from the IRF to the community, and 30-day hospital events by estimating adjusted relative risk (aRR) using modified Poisson regression and the relative difference in IRF length of stay (LOS) using Gamma regression. Results A total of 1323 patients were included. Patients with moderately low, (aRR = 1.50; 95% CI = 1.15–1.93), moderately high (aRR = 1.52; 95% CI = 1.16–2.01), or high (aRR = 1.37; 95% CI = 1.02–1.85) PF at hospital discharge were more likely than those with very low PF to improve their PF while in the IRF. These same patients were more likely to discharge from IRF to the community and had significantly shorter IRF LOS. Hospital-measured PF did not differentiate risk for 30-day hospital events. Conclusion Patients with moderate—but not very low or very high—PF measured near the time of acute hospital discharge were likely to achieve meaningful PF improvement in an IRF. They also had a shorter IRF LOS so may be ideal candidates for discharge to IRF. Prospective studies with larger samples are necessary to test this assertion. Impact Providers in the hospital should identify patients with moderate PF near the time of hospital discharge as those who may benefit most from post-acute rehabilitation in an IRF.

Patient Safety Trilogy: Perspectives from Clinical Engineering

2013 ◽  
Vol 47 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Izabella Gieras ◽  
Paul Sherman ◽  
Dennis Minsent
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Engineering ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Technology ◽  
Academic Medical ◽  
Clinical Engineers

This article examines the role a clinical engineering or healthcare technology management (HTM) department can play in promoting patient safety from three different perspectives: a community hospital, a national government health system, and an academic medical center. After a general overview, Izabella Gieras from Huntington Hospital in Pasadena, CA, leads off by examining the growing role of human factors in healthcare technology, and describing how her facility uses clinical simulations in medical equipment evaluations. A section by Paul Sherman follows, examining patient safety initiatives from the perspective of the Veterans Health Administration with a focus on hazard alerts and recalls. Dennis Minsent from Oregon Health & Science University writes about patient safety from an academic healthcare perspective, and details how clinical engineers can engage in multidisciplinary safety opportunities.

scholarly journals The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

2018 ◽  
Vol 10 (5) ◽  
pp. 583-586 ◽  
Author(s):  
Matthew Gorgone ◽  
Brian McNichols ◽  
Valerie J. Lang ◽  
William Novak ◽  
Alec B. O'Connor
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medical Providers ◽  
Procedural Training ◽  
Academic Medical ◽  
Attending Physician ◽  
Attending Physicians ◽  
The Impact ◽  
Training Opportunities

ABSTRACT Background  Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective  We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods  We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results  Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions  The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

scholarly journals COVID-19 and Cognitive Impairment: Severity, Evolution, and Functional Impact during Inpatient Rehabilitation

2021 ◽  
Author(s):  
Ruchi Patel ◽  
Irene Savrides ◽  
Christine Cahalan ◽  
Gargi Doulatani ◽  
Michael W. O'Dell ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Medical Center ◽  
Academic Medical Center ◽  
Inpatient Rehabilitation ◽  
Prior History ◽  
Rehabilitation Unit ◽  
Minimally Clinically Important Difference ◽  
Cross Sectional ◽  
Functional Gain

Objective: To determine the frequency, magnitude, and change in cognitive impairment in patients with COVID-19 undergoing acute inpatient rehabilitation. We secondarily evaluated correlates of cognitive impairment and the relationship between cognition and functional gain. Design: Cross-sectional observational study with assessments at admission and discharge Setting: Acute inpatient rehabilitation unit within a large, urban academic medical center Participants: 77 patients hospitalized for COVID-19 and subsequently admitted to an inpatient rehabilitation unit between March-August 2020, 45 of whom were re-assessed at discharge. Interventions: N/A Main Outcome Measures: Montreal Cognitive Assessment (MoCA) scores on admission and discharge (when available) and Quality Indicator for Self-Care (QI-SC) scores on admission and discharge. Results: 62/77 (80.5%) of patients demonstrated cognitive deficits on the MoCA at admission: 39/77 (50.6%) were mildly impaired, 20/77 (26%) moderately impaired, and 3/77 (3.9%) severely impaired. Cognitive impairment was associated with a prior history of delirium, but not age or length of acute care hospitalization. 32/45 (71.1%) patients with discharge scores improved and met the MoCA minimally clinically important difference (MCID); however, 35/45 (77.8%) continued to score in the impaired range. Patients who met the MoCA MCID demonstrated significantly greater QI-SC score gains than those that did not meet the MCID (p=.02). Conclusion: Cognitive impairment is common among hospitalized COVID-19 patients requiring acute inpatient rehabilitation. Cognitive impairment improves over the course of inpatient rehabilitation, and is associated with functional gain. Nonetheless, cognitive deficits frequently remain present at discharge, indicating the need for systematic assessment and follow-up, especially given the association with functional outcome.

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