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Journal articles on the topic "Boston Visitors Center"
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Rhee, Chanu, Meghan Baker, Vineeta Vaidya, Robert Tucker, Andrew S. Resnick, Charles Morris, and Michael Klompas. "1. Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large U.S. Academic Medical Center." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S1. http://dx.doi.org/10.1093/ofid/ofaa417.000.
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Abstract Background Many patients are avoiding essential care for fear of contracting Covid-19 in healthcare settings. However, the incidence of nosocomial Covid-19 infection in U.S. acute care hospitals is unknown. Methods We conducted an observational study of all patients admitted to Brigham and Women’s Hospital in Boston, Massachusetts between March 7 (when the first Covid-19 patient was admitted) and May 30, 2020. During this period, a comprehensive infection control program was implemented including dedicated Covid-19 units with airborne infection isolation rooms, personal protective equipment (PPE) in accordance with CDC recommendations, PPE donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. We reviewed the medical records of all patients who tested positive for SARS-CoV-2 by RT-PCR on hospital day 3 or later or within 14 days of hospital discharge to determine whether infection was community or hospital-acquired based on timing of RT-PCR tests, clinical course, and exposures. Results Over the 12-week period, 9,149 patients were admitted, in whom 7,394 SARS-CoV-2 RT-PCR tests were performed and 697 Covid-19 cases were confirmed, translating into a total 8,656 days of Covid-19-related care (Figure). The inpatient Covid-19 census peaked at 171 on April 21. Twelve of the 697 Covid-19 patients (1.7%) were first diagnosed by RT-PCR on hospital day 3 or later (median 4 days, range 3–15 days). Of these, only one was deemed hospital-acquired and was most likely acquired from his pre-symptomatic spouse who was visiting daily and diagnosed with Covid-19 before visitor restrictions were implemented. Amongst 8,370 non-Covid-19 patients discharged through June 17, 11 (0.1%) subsequently tested positive within 14 days (median time to diagnosis 6 days, range 1–14). Only one was deemed likely to have been hospital-acquired, albeit with no known exposures. Figure. Timeline of implementation of major infection control policies and cumulative number of hospitalized COVID-19 cases (total and hospital-onset) Conclusion Nosocomial Covid-19 infection was exceedingly rare during the height of the pandemic in a hospital with rigorous infection control measures. Our findings may inform practices in other institutions and provide reassurance to patients regarding the safety of receiving care in acute care hospitals. Disclosures All Authors: No reported disclosures
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Matos Rodrííguez, Féélix V. ""The 'Browncoats' are Coming": Latino Public History in Boston." Public Historian 23, no. 4 (2001): 15–28. http://dx.doi.org/10.1525/tph.2001.23.4.15.
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This essay will attempt to explain why it has taken so long for the city/state and public history organizations in Boston to begin to embrace the heritage of its Latino/a communities in public history projects. It will contextualize early attempts in the 1970s and 1980s to develop and promote Latino/a public history projects and exhibits and will discuss changes that have occurred in the 1990s. The second part of the essay will discuss how issues of representation, power, and participation have been addressed by two recent projects that have attempted to incorporate Latino/a history in Boston. The city of Boston has been selected as a case-study for a number of reasons. First, Boston is one of a few cities in the U.S. where public history projects have national repercussions. The combination of a high concentration of institutions of higher education, and the city's attractiveness to visitors fascinated by the U.S. colonial, maritime and independence history makes Boston a national leader in the field of public history. Second, the situation in Boston -- where increased hostility towards immigrants, affirmative action, and bilingualism - is representative of recent trends in urban centers throughout the U.S and allows for important comparisons. Finally, the selection of Boston is significant because it breaks from traditional studies that limit Latino/a history issues to cities that have a larger percentage of Latinos/as in its population such as Houston, Los Angeles, Miami, and New York. Within the small field of Latino/a public history including case studies of cities such as Boston is crucial because Boston is probably more representative of national trends than are the large cities mentioned earlier.
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Mayer, Kenneth H., Kenneth Levine, Chris Grasso, Ami Multani, Alex Gonzalez, and Katie Biello. "541. Rapid Migration to Telemedicine in a Boston Community Health Center is Associated with Maintenance of Effective Engagement in HIV Care." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S337—S338. http://dx.doi.org/10.1093/ofid/ofaa439.735.
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Abstract Background The COVID-19 pandemic has disrupted many health care activities. The impact of the pandemic on HIV primary care in a Boston community health center (CHC) that has specialized HIV, sexual and gender minority care is analyzed here. Methods The CHC has used the Centricity Practice SolutionTM electronic medical record (EMR) system since 1997. The current analyses used data abstracted from the EMR, testing for significant differences in HIV care utilization using the Student t-test for means and chi-square tests for proportions. Results There were 2,016 HIV+ patients among 25,606 patients (7.9%) engaged in primary care in 2019. In 2019, HIV+ patients had between 563 and 689 in-person visits per month. On average, monthly visits for HIV care increased (p< 0.0001) in the first two months of 2020 (mean=626, sd=60.1) compared to 2019 (mean=617, sd=40.6), but dropped to 370 and 36 in person visits by HIV+ patients in March and April 2020 respectively (mean=203, sd=236.2; p< 0.0001), when statewide stay-at-home policies were recommended. There were 263 telemedicine visits by HIV+ patients in March and 751 in April, 2020. When telemedicine and in-person visits were combined, mean number of visits per month by HIV+ patients were higher compared to the same two-month period in 2019 (p< .0001). The mean number of plasma HIV RNA viral load (VL) tests performed each month was 279 in 2019 (range 257–312, sd=18.3), versus 219 in March and 274 in April 2020 (mean=246.5, sd=38.9; p< 0.0001). Among those tested, monthly rates of virological suppression ranged from 71–81% in 2019, with 11–20% having VL < 100 copies/ml. Eighty percent had an undetectable VL as their last measurement in 2019; an additional 14% had last VL detectable but < 100 copies/ml. In March and April, 2020, the rates of VL suppression were 77% and 74% and 14% and 18% had VL detectable but < 100 copies/ml, respectively (p=0.209). Conclusion The COVID-19 pandemic has led to a significant decrease in in-person visits by HIV+ and other patients at a Boston CHC, but with a rapid migration to the use of telemedicine, patient engagement, as expressed by visits and VL suppression does not appear to be adversely affected Disclosures All Authors: No reported disclosures
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Ma, Clement, Madhumitha Sridharan, Hasan Al-Sayegh, Anran Li, Dongjing Guo, Mark Auclair, Vani Kuragayala, et al. "Building a Harmonized Datamart by Integrating Cross-Institutional Systems of Clinical, Outcome, and Genomic Data: The Pediatric Patient Informatics Platform (PPIP)." JCO Clinical Cancer Informatics, no. 5 (February 2021): 202–15. http://dx.doi.org/10.1200/cci.20.00083.
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PURPOSE Siloed electronic medical data limits utility and accessibility. At the Dana-Farber/Boston Children's Cancer and Blood Disorders Center, cross-institutional data were inconsistent and difficult to access. To unify data for clinical operations, administration, and research, we developed the Pediatric Patient Informatics Platform ( PPIP), an integrated datamart harmonizing multiple source systems across two institutions into a common technology. PATIENTS AND METHODS Starting in 2009, user requirements were gathered and data sources were prioritized. Project teams, including biostatisticians, database developers, and an external contractor, were formed. Read-access to source systems was established. The 3-layer PPIP architecture was developed: STAGING, a near-exact copy of source data; INTEGRATION, where data were reorganized into domains; and, CONSUMPTION, where data were optimized for rapid retrieval. The diverse systems were integrated into a common IBM Netezza technology. Data filters were defined to accurately capture the Center's patients, and derived data items were created for harmonization across sources. An interactive online query tool, PPIP360, was developed using Microstrategy Analytics. RESULTS Driven by scientific objectives, the PPIP datamart was created, including 33,674 patients, 2,983 protocols, and 3.6 million patient visits from 14 source databases, 164 source tables, and 2,622 source data items. The PPIP360 has 605 data items and 33 metrics across 11 reports and dashboards. Dana-Farber and Boston Children's established a legal data-sharing agreement. The PPIP has supported hundreds of faculty, staff, and projects, including planning clinical trials and informing strategic planning. CONCLUSION The PPIP has successfully harmonized and integrated diagnostic, demographic, laboratory, treatment, clinical outcome, pathology, transplant, meta-protocol, and –omics data, for efficient, daily operational and research activities at Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and future external sharing.
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Lee, ChangWon C., Faye F. Holder-Niles, Linda Haynes, Jenny Chan Yuen, Corinna J. Rea, Kathleen Conroy, Joanne E. Cox, and Clement J. Bottino. "Associations Between Patient-Reported Outcome Measures of Asthma Control and Psychosocial Symptoms." Clinical Pediatrics 58, no. 3 (November 21, 2018): 307–12. http://dx.doi.org/10.1177/0009922818812479.
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There is growing emphasis on using patient-reported outcome measures to enhance clinical practice. This study was a retrospective review of scores on the Childhood Asthma Control Test (C-ACT) and the Pediatric Symptom Checklist-17 (PSC-17) at a pediatric primary care center in Boston, Massachusetts. A total of 218 patients were selected at random using billing codes for well-child (WC) care and asthma, excluding complex medical conditions. Cutoff scores were used to identify uncontrolled asthma (C-ACT ⩽19) and clinically significant psychosocial symptoms (+PSC-17). Multiple logistic regression was used to measure associations between C-ACT ⩽19 and +PSC-17, adjusting for covariates. In multivariable analysis, C-ACT ⩽19 at WC visits was associated with +PSC-17 at WC visits (adjusted odds ratio = 3.2 [95% confidence interval = 1.3-8.6]). C-ACT ⩽19 at non-WC visits was also associated with +PSC-17 at WC visits (adjusted odds ratio = 3.1 [95% confidence interval = 1.2-8.9]). Patient-reported outcome measures of asthma control and psychosocial symptoms were positively correlated in this sample.
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Sahasrabudhe, Neha, Jong Soo Lee, Tammy M. Scott, Laura Punnett, Katherine L. Tucker, and Natalia Palacios. "Serum Vitamin D and Depressive Symptomatology among Boston-Area Puerto Ricans." Journal of Nutrition 150, no. 12 (October 6, 2020): 3231–40. http://dx.doi.org/10.1093/jn/nxaa253.
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ABSTRACT Background Low vitamin D status, assessed using serum 25-hydroxyvitamin D [25(OH)D] concentration, has been associated with depression, but research among minority populations, such as Puerto Ricans is limited. We examined the association between serum 25(OH)D and self-reported depressive symptomatology across 3 waves of follow-up in a cohort of Puerto Rican adults residing in Massachusetts. Objectives We evaluated the cross-sectional and longitudinal associations between serum 25(OH)D and self-reported depressive symptoms in the Boston Puerto Rican Health Study (BPRHS) cohort. Methods Participants of the BPRHS were evaluated for depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Serum 25(OH)D was measured at baseline (n = 1434), year 2 (n = 1218), and year 5 (n = 914). We categorized serum 25(OH)D concentration as sufficient (≥20 ng/mL), insufficient (12 to <20 ng/mL), and deficient (<12 ng/mL). Multivariable linear regression was used for cross-sectional analyses at baseline, and repeated measures mixed effects modeling was used over 3 waves of follow-up for longitudinal analyses. We conducted sensitivity analyses in vitamin D supplement nonusers and participants with complete data on baseline serum 25(OH)D and CES-D at all 3 visits. Results Serum 25(OH)D concentration was not associated with CES-D score in cross-sectional analysis [β = −0.85; 95% CI: −2.80, 1.10 for deficient compared with sufficient 25(OH)D; P-trend = 0.59] or in longitudinal analyses over 5 y [β = −0.41; 95% CI: −1.95, 1.13 for deficient compared with sufficient 25(OH)D; P-trend = 0.93]. Results were similar in sensitivity analyses restricted to vitamin D supplement nonusers (n = 1371) and in analyses conducted in participants with complete measures of baseline serum 25(OH)D and CES-D score at all 3 visits (n = 887) [β = −0.12; 95% CI: −1.98, 1.74 for deficient compared with sufficient 25(OH)D; P-trend = 0.93]. Conclusions We did not observe a significant association between serum 25(OH)D and depressive symptomatology in the BPRHS cohort.
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Brady, Cassandra C., Vidhu V. Thaker, Todd Lingren, Jessica G. Woo, Stephanie S. Kennebeck, Bahram Namjou-Khales, Ashton Roach, et al. "Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers." International Journal of Pediatrics 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/4068582.
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Background and Objectives.The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals.Methods.We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children’s Hospital and Cincinnati Children’s Hospital and Medical Center between 2007 and 2014.Results.A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%,p<0.001), African American children (27% versus 19% in whites,p<0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics,p<0.001).Conclusions.There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.
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Horng, Steven, Nathaniel R. Greenbaum, Larry A. Nathanson, James C. McClay, Foster R. Goss, and Jeffrey A. Nielson. "Consensus Development of a Modern Ontology of Emergency Department Presenting Problems—The Hierarchical Presenting Problem Ontology (HaPPy)." Applied Clinical Informatics 10, no. 03 (May 2019): 409–20. http://dx.doi.org/10.1055/s-0039-1691842.
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Objective Numerous attempts have been made to create a standardized “presenting problem” or “chief complaint” list to characterize the nature of an emergency department visit. Previous attempts have failed to gain widespread adoption as they were not freely shareable or did not contain the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges. Materials and Methods We prospectively captured the presenting problems for 180,424 consecutive emergency department patient visits at an urban, academic, Level I trauma center in the Boston metro area. No patients were excluded. We used a consensus process to iteratively derive our system using real-world data. We used the first 70% of consecutive visits to derive our ontology, followed by a 6-month washout period, and the remaining 30% for validation. All concepts were mapped to Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT). Results Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 nonvisible descriptions to correct misspellings and nonstandard terminology. Our ontology successfully captured structured data for 95.9% of visits in our validation data set. Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived and then iteratively validated by an expert consensus panel. HaPPy contains 692 presenting problem concepts, each concept being mapped to SNOMED CT. This freely sharable ontology can help to facilitate presenting problem-based quality metrics, research, and patient care.
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Correll, Darin J., Angela M. Bader, Melissa W. Hull, Cindy Hsu, Lawrence C. Tsen, and David L. Hepner. "Value of Preoperative Clinic Visits in Identifying Issues with Potential Impact on Operating Room Efficiency." Anesthesiology 105, no. 6 (December 1, 2006): 1254–59. http://dx.doi.org/10.1097/00000542-200612000-00026.
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Background Preoperative clinics have been shown to decrease operating room delays and cancellations. One mechanism for this positive economic impact is that medical issues are appropriately identified and necessary information is obtained, so that knowledge of the patients' status is complete before the day of surgery. In this study, the authors describe the identification and management of medical issues in the preoperative clinic. Methods All patients coming to the Preoperative Clinic during a 3-month period from November 1, 2003, through January 31, 2004, at the Brigham and Women's Hospital, Boston, Massachusetts, were studied. Data were collected as to the type of issue, information needed to resolve the issue, time to retrieve the information, cancellation and delay rates, and the effect on management. Results A total of 5,083 patients were seen in the preoperative clinic over the three-month period. A total of 647 patients had a total of 680 medical issues requiring further information or management. Of these issues, 565 were thought to require further information regarding known medical problems, and 115 were new medical problems first identified in the clinic. Most of the new problems required that a new test or consultation be done, whereas most of the old problems required retrieval of information existing from outside medical centers. New problems had a far greater probability of delay (10.7%) or cancellation (6.8%) than old problems (0.6% and 1.8%, respectively). Conclusions The preoperative evaluation can identify and resolve a number of medical issues that can impact efficient operating room resource use.
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Tully, Phillip J., Ruth Peters, Karine Pérès, Kaarin J. Anstey, and Christophe Tzourio. "Effect of SSRI and calcium channel blockers on depression symptoms and cognitive function in elderly persons treated for hypertension: three city cohort study." International Psychogeriatrics 30, no. 9 (March 21, 2018): 1345–54. http://dx.doi.org/10.1017/s1041610217002903.
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ABSTRACTBackground:Emerging genetic, ex-vivo, and clinical trial evidence indicates that calcium channel blockers (CCB) can improve mood and cognitive function. The objective of this study was to examine the effect of selective serotonin reuptake inhibitor (SSRI) therapy augmented with CCB on depression and cognitive decline in an elderly population with hypertension.Methods:Prospective study of 296 persons treated with SSRI and antihypertensive drugs. Baseline and two year clinic assessments were used to categorize participants as users of SSRI + CCB (n = 53) or users of SSRI + other antihypertensives (n = 243). Clinic visits were performed up to four times in a ten-year period to assess depression and cognitive function.Results:The sample mean age was 75.2 ± 5.47 years and 78% of participants were female. At two year follow-up there was a significant group by time interaction showing lower Center for Epidemiological Studies-Depression (CESD) scores in the SSRI + CCB group, F(1,291) = 4.13, p = 0.043, η2p = 0.014. Over ten-years follow-up, SSRI + CCB use was associated with improved general cognitive function (Mini-Mental State Examination: β = 0.97; 95% CI 0.14 to 1.81, p = 0.023) and immediate visual memory (Boston Visual Retention Test: β = 0.69; 95% CI 0.06 to 1.32, p = 0.033).Conclusion:The findings provide general population evidence that SSRI augmentation with CCB may improve depression and cognitive function.
Books on the topic "Boston Visitors Center"
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British Library. The British Library, Boston Spa: A guide to visitor services. Boston Spa: British Library, 1995.
Find full textBook chapters on the topic "Boston Visitors Center"
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Rothstein, William G. "Medical Care and Medical Education, 1750–1825." In American Medical Schools and the Practice of Medicine. Oxford University Press, 1987. http://dx.doi.org/10.1093/oso/9780195041866.003.0008.
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Medical care at the end of the eighteenth century, like that in any period, was determined by the state of medical knowledge and the available types of treatment. Some useful knowledge existed, but most of medical practice was characterized by scientific ignorance and ineffective or harmful treatments based largely on tradition. The empirical nature of medical practice made apprenticeship the dominant form of medical education. Toward the end of the century medical schools were established to provide the theoretical part of the student’s education, while apprenticeship continued to provide the practical part. The scientifically valid aspects of medical science in the late eighteenth century comprised gross anatomy, physiology, pathology, and the materia medica. Gross anatomy, the study of those parts of the human organism visible to the naked eye, had benefitted from the long history of dissection to become the best developed of the medical sciences. This enabled surgeons to undertake a larger variety of operations with greater expertise. Physiology, the study of how anatomical structures function in life, had developed at a far slower pace. The greatest physiological discovery up to that time, the circulation of the blood, had been made at the beginning of the seventeenth century and was still considered novel almost two centuries later. Physiology was a popular area for theorizing, and the numerous physiologically based theories of disease were, as a physician wrote in 1836, “mere assumptions of unproved, and as time has demonstrated, unprovable facts, or downright imaginations.” Pathology at that time was concerned with pathological or morbid anatomy, the study of the changes in gross anatomical structures due to disease and their relationship to clinical symptoms. The field was in its infancy and contributed little to medicine and medical practice. Materia medica was the study of drugs and drug preparation and use. Late eighteenth century American physicians had available to them a substantial armamentarium of drugs. Estes studied the ledgers of one New Hampshire physician from 1751 to 1787 (3,701 patient visits), and another from 1785 to 1791 (1,161 patient visits), one Boston physician from 1782 to 1795 (1,454 patient visits), and another from 1784 to 1791 (779 patient visits).