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Academic Hospitals (academic + hospital)
Selected AbstractsInfliximab treatment for Crohn's disease: One-year experience in a Dutch Academic HospitalINFLAMMATORY BOWEL DISEASES, Issue 2 2002Dr. Daan W. Hommes Abstract The aim of this study was to report the 1-year clinical experience with infliximab treatment for Crohn's disease (CD) in the Netherlands. All 73 CD patients receiving infliximab infusions were prospectively followed during 1 year after the drugs' registration in the Netherlands. Clinical response and adverse events were assessed for both active luminal disease as well as fistulous disease. A total of 212 infusions were administered to 57 patients with active luminal CD and 16 patients with fistulous CD. The mean duration between infusions was 60 days. In 17% of patients, adverse events were recorded, of which one was serious. The response rate was 81% in active luminal CD and 87% in fistulous disease. Response rates were highest in patients receiving concomitant methotrexate as maintenance therapy. Steroids could successfully be tapered off in 73% of responding luminal CD patients and 100% of responding CD patients with fistulae. Eleven patients showed a loss of response to continuous infliximab readministration. Our clinical experience with infliximab for active luminal and fistulous CD showed that the administration is safe, effective, and has high steroid-sparing efficacy. Higher response rates were seen with methotrexate as concomitant medication. [source] Metabolic syndrome in young women with the polycystic ovary syndrome: revisiting the threshold for an abnormally decreased high-density lipoprotein cholesterol serum levelBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2010D Dewailly Please cite this paper as: Dewailly D, Contestin M, Gallo C, Catteau-Jonard S. Metabolic syndrome in young women with the polycystic ovary syndrome: revisiting the threshold for an abnormally decreased high-density lipoprotein cholesterol serum level. BJOG 2010;117:175,180. Objective, To verify whether the adult threshold for an abnormally decreased high-density lipoprotein cholesterol (HDL-C) serum level (0.5 g/l) is appropriate in young women with polycystic ovary syndrome (PCOS). Design, Retrospective analysis of a database. Setting, Academic Hospital. Population, A total of 854 women aged 16,40 years having PCOS according to Rotterdam criteria. Methods, Criteria defining the metabolic syndrome (MetS) (increased waist circumference, systolic and/or diastolic blood pressure, triglycerides, fasting glycaemia and decreased HDL-C) were separately analysed and compared in three different subgroups (16,20 years, 20,30 years and 30,40 years). The prevalence of the MetS was calculated using two different thresholds (0.5 and 0.4 g/l) for HDL-C in the 16,20 years group. Main outcomes measures, Prevalence of MetS. Results, The prevalence of an abnormal HDL-C (<0.5 g/l) was higher in the youngest women (60%), whereas frequencies of abnormal waist circumference, systolic and/or diastolic blood pressure, triglycerides and fasting glycaemia were lower than in the two other groups. The prevalence of an abnormal HDL-C dropped to 27% when using a threshold of 0.4 g/l in the 16,20 years subgroup. The prevalence of the MetS in the 16,20 years subgroup was 11%, whatever the threshold, because HDL-C was <0.4 g/l in all women once they scored 3 or more. Conclusions, The adult threshold for HDL-C overestimates the prevalence of abnormal HDL-C in young women with PCOS. Until normative data about HDL-C in adult women under 20 years is available, we suggest using a threshold of 0.4 g/l or ignoring this criterion. [source] Emergence and diversity of different HIV-1 subtypes in South Africa, 2000,2001JOURNAL OF MEDICAL VIROLOGY, Issue 11 2009G.B. Jacobs Abstract HIV-1 is a major health problem in South Africa with an average prevalence rate of 29.1% in pregnant women and between 4.9 and 6.1 million people infected. Using env gp120 V3 serotyping and genotyping techniques 410 patient samples were investigated. Most of the samples were obtained from different clinics in the greater Cape Town area of the Western Cape Province in South Africa. These included an academic hospital, state and private clinics, an informal settlement, sex worker cohorts, and the blood transfusion services. RNA was extracted from plasma samples followed by RT-PCR and sequencing of the env gp120 V3 region. Sequence fragments were assembled using Sequencher V4.7 and subsequently codon aligned. Distance calculation, tree construction methods, and bootstrap analysis were implemented using MEGA version 4.0. Viral load measurements indicated that HIV-1 RNA levels from 74 samples were below the assay detection limit. Three hundred thirty-six samples were used for env PCR and sequencing and 320 were assigned to subtypes. The majority of the sequences were subtyped as C (n,=,285, 89.0%). Other subtypes detected were subtype A (n,=,10, 3.1%); subtype B (n,=,22, 6.8%); one each of subtypes F1, G, U, and a CH recombinant. Whether this diversity will have major implications for HIV-1 evolution and vaccine development in this region remains undetermined. J. Med. Virol. 81:1852,1859, 2009. © 2009 Wiley-Liss, Inc. [source] Impact of clinical leadership development on the clinical leader, nursing team and care-giving process: a case studyJOURNAL OF NURSING MANAGEMENT, Issue 6 2008BERNADETTE DIERCKX de CASTERLÉ phd Aim, This study explored the dynamics related to a leadership development programme and their impact on the clinical leader, the nursing team and the care-giving process. Background, While there is a growing conviction about the need to invest in transformational leadership in nursing, further insight into the true complexity of leadership development and, more specifically, how leadership can make a difference in nursing and patient outcomes is essential. Method, A single instrumental case study was conducted in a unit of a large academic hospital where a Clinical Leadership development Project (CLP) was implemented successfully. We used mixed methods with multiple sources of data to capture the complexity of leadership development. Data were collected through individual interviews, focus groups and observation of participants. A purposive sample of 17 participants representing a wide variety of team members has permitted data saturation. The data were categorized and conceptualized and finally organized into a framework describing leadership development on the unit and its impact on the leader, the nursing team and the care-giving process. Results, Leadership development is an ongoing, interactive process between the clinical leader and the co-workers. The head nurse became more effective in areas of self-awareness, communication skills, performance and vision. The nursing team benefited because more effective leadership promoted effective communication, greater responsibility, empowerment and job clarity. Improved clinical leadership seemed also to influence patient-centred communication, continuity of care and interdisciplinary collaboration. Conclusions, The results of the study give more insight into the processes underlying the leader's progress towards attaining a transformational leadership style and its impact on the team members. The impact of leadership on the care-giving process, however, remains difficult to describe. Implications for nursing management, The interactive nature of leadership development makes CLP a challenge for the leader as well for the team members. Through its impact on the leader and the nursing team, CLP is a valuable instrument for improving work environments of nurses, contributing positively to patient-centred care. [source] The Association Between Emergency Department Crowding and Adverse Cardiovascular Outcomes in Patients with Chest PainACADEMIC EMERGENCY MEDICINE, Issue 7 2009Jesse M. Pines MD Abstract Objectives:, While emergency department (ED) crowding is a worldwide problem, few studies have demonstrated associations between crowding and outcomes. The authors examined whether ED crowding was associated with adverse cardiovascular outcomes in patients with chest pain syndromes (chest pain or related complaints of possible cardiac origin). Methods:, A retrospective analysis was performed for patients ,30 years of age with chest pain syndrome admitted to a tertiary care academic hospital from 1999 through 2006. The authors compared rates of inpatient adverse outcomes from ED triage to hospital discharge, defined as delayed acute myocardial infarction (AMI), heart failure, hypotension, dysrhythmias, and cardiac arrest, which occurred after ED arrival using five separate crowding measures. Results:, Among 4,574 patients, 251 (4%) patients developed adverse outcomes after ED arrival; 803 (18%) had documented acute coronary syndrome (ACS), and of those, 273 (34%) had AMI. Compared to less crowded times, ACS patients experienced more adverse outcomes at the highest waiting room census (odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.3 to 11.0) and patient-hours (OR = 5.2, 95% CI = 2.0 to 13.6) and trended toward more adverse outcomes during time of high ED occupancy (OR = 3.1, 95% CI = 1.0 to 9.3). Adverse outcomes were not significantly more frequent during times with the highest number of admitted patients (OR = 1.6, 95% CI = 0.6 to 4.1) or the highest trailing mean length of stay (LOS) for admitted patients transferred to inpatient beds within 6 hours (OR = 1.5, 95% CI = 0.5 to 4.0). Patients with non-ACS chest pain experienced more adverse outcomes during the highest waiting room census (OR = 3.5, 95% CI = 1.4 to 8.4) and patient-hours (OR = 4.3, 95% CI = 2.6 to 7.3), but not occupancy (OR = 1.8, 95% CI = 0.9 to 3.3), number of admitted patients (OR = 0.6, 95% CI 0.4 to 1.1), or trailing LOS for admitted patients (OR = 1.2, 95% CI = 0.6 to 2.0). Conclusions:, There was an association between some measures of ED crowding and a higher risk of adverse cardiovascular outcomes in patients with both ACS-related and non,ACS-related chest pain syndrome. [source] From Model to Forecasting: A Multicenter Study in Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 9 2010Mathias Wargon MD ACADEMIC EMERGENCY MEDICINE 2010; 17:970,978 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study investigated whether mathematical models using calendar variables could identify the determinants of emergency department (ED) census over time in geographically close EDs and assessed the performance of long-term forecasts. Methods:, Daily visits in four EDs at academic hospitals in the Paris area were collected from 2004 to 2007. First, a general linear model (GLM) based on calendar variables was used to assess two consecutive periods of 2 years each to create and test the mathematical models. Second, 2007 ED attendance was forecasted, based on a training set of data from 2004 to 2006. These analyses were performed on data sets from each individual ED and in a virtual mega ED, grouping all of the visits. Models and forecast accuracy were evaluated by mean absolute percentage error (MAPE). Results:, The authors recorded 299,743 and 322,510 ED visits for the two periods, 2004,2005 and 2006,2007, respectively. The models accounted for up to 50% of the variations with a MAPE less than 10%. Visit patterns according to weekdays and holidays were different from one hospital to another, without seasonality. Influential factors changed over time within one ED, reducing the accuracy of forecasts. Forecasts led to a MAPE of 5.3% for the four EDs together and from 8.1% to 17.0% for each hospital. Conclusions:, Unexpectedly, in geographically close EDs over short periods of time, calendar determinants of attendance were different. In our setting, models and forecasts are more valuable to predict the combined ED attendance of several hospitals. In similar settings where resources are shared between facilities, these mathematical models could be a valuable tool to anticipate staff needs and site allocation. [source] Surgeons and scientists: Working together in embryo researchJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 1 2009Alison P. Murdoch Abstract Most surgeons in academic hospitals will have had a request from an enthusiastic research scientist to take samples of tissue during an operation. It seems reasonable and most patients will respond positively. But of course it is not quite that simple. The regulation of donation of human tissue for basic research is clearly defined but usually less rigorous than that which covers translational research and clinical trials. An exception has been the donation of embryos for embryonic stem cell derivation. The specific issues related to obtaining cells from patients for this work has resulted in a different relationship between scientist and clinician. This will be considered. J. Cell. Biochem. 108: 1,2, 2009. © 2009 Wiley-Liss, Inc. [source] Well-being in residency: a time for temporary imbalance?MEDICAL EDUCATION, Issue 3 2007Neda Ratanawongsa Context, Previous quantitative studies about doctor well-being have focused primarily on negative well-being, such as burnout. We conducted this study to understand residents' perspectives on well-being. Methods, We conducted 45-minute interviews with residents from 9 residencies at 2 academic hospitals in Baltimore, Maryland. From February to June 2005, we approached 49 residents through random sampling stratified by programme and gender. The semi-structured instrument elicited descriptions of well-being in residency and factors related to its promotion or reduction. Using an editing analysis style, investigators independently coded transcripts, agreeing on the coding template and its application. Results, The 26 participating residents came from internal medicine (3 programmes), psychiatry, surgery, emergency medicine, anaesthesia, obstetrics and gynaecology, and paediatrics. Six themes emerged: balance among multiple domains; professional development and temporary imbalance; professional satisfaction and accomplishment; maintaining a sense of self; stressors and coping strategies, and the role of residency programmes. Residents described well-being as a balance among multiple domains, including professional development, relationships, and physical and mental health. They viewed residency as a time for temporary imbalance, during which they invested in professional development at the expense of other domains. Some residents described feeling a ,loss of self'. Residents revealed strategies for coping with stressors and endorsed ways in which training programmes helped to enhance their well-being. Conclusions, Resident well-being was closely connected to professional development and required varying degrees of self-sacrifice with a re-balancing of personal priorities. These findings should be considered by training programmes that are interested in enhancing resident well-being. [source] Multicenter Validation of the Philadelphia EMS Admission Rule (PEAR) to Predict Hospital Admission in Adult Patients Using Out-of-hospital DataACADEMIC EMERGENCY MEDICINE, Issue 6 2009Zachary F. Meisel MD Abstract Objectives:, The objective was to validate a previously derived prediction rule for hospital admission using routinely collected out-of-hospital information. Methods:, The authors performed a multicenter retrospective cohort study of 1,500 randomly selected, adult patients transported to six separate emergency departments (EDs; three community and three academic hospitals in three separate health systems) by a city-run emergency medical services (EMS) system over a 1-year period. Patients younger than 18 years or who bypassed the ED to be evaluated by trauma, obstetric, or psychiatric teams were excluded. The score consisted of six weighted elements that generated a total score (0,14): age , 60 years (3 points); chest pain (3); shortness of breath (3); dizzy, weakness, or syncope (2); history of cancer (2); and history of diabetes (1). Receiver operator characteristic (ROC) curves for the decision rule and admission rates were calculated among individual hospitals and for the entire cohort. Results:, A total of 1,102 patients met inclusion criteria. The admission rate for the entire cohort was 40%, and individual hospital admission rates ranged from 28% to 57%. Overall, 34% had a score of ,4, and 29% had a score of ,5. Area under the ROC curve (AUC) for the combined cohort was 0.83 for all admissions and 0.72 for intensive care unit (ICU) admissions; AUCs at individual hospitals ranged from 0.72 to 0.85. The admission rate for a score of ,4 was 77%; for a score of ,5 the admission rate was 80%. Conclusions:, The ability of this EMS rule to predict the likelihood of hospital admission appears valid in this multicenter cohort. Further studies are needed to measure the impact and feasibility of using this rule to guide decision-making. [source] | |||||||||||||