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Journal articles on the topic 'Lahey Clinic Medical Center'

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Published: 4 June 2021

Last updated: 7 February 2022

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1

Cohen, Michael S., Robert S. Hanley, Teodora Kurteva, Robin Ruthazer, Mark L. Silverman, Andrea Sorcini, Karim Hamawy, Robert A. Roth, Ingolf Tuerk, and John A. Libertino. "Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System: The Lahey Clinic Medical Center Experience and an International Meta-Analysis." European Urology 54, no. 2 (August 2008): 371–81. http://dx.doi.org/10.1016/j.eururo.2008.03.049.

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2

Archambault, Ashley Joan, Charles F. Arkin, Tim Skelton, Gyorgy Abel, and John Gawoski. "The Fall of the Erythrocyte Sedimentation Rate." Blood 118, no. 21 (November 18, 2011): 4774. http://dx.doi.org/10.1182/blood.v118.21.4774.4774.

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Abstract Abstract 4774 The Fall of the Erythrocyte Sedimentation Rate, Ashley J. Archambault, MLS(ASCP), Gyorgy Abel, MD, PhD, John Gawoski, MD, Tim Skelton, MD, PhD, Charles Arkin, MD, Department of Laboratory Medicine, Lahey Clinic Medical Center, Burlington MA The Erythrocyte Sedimentation Rate (ESR) is widely used to indicate the presence of active inflammation, particularly in rheumatic and infectious disorders. It has long been a mainstay in diagnostic protocols, as well as being a standard in the work-up of temporal arteritis. However, despite its entrenchment in the minds of many physicians, an increasing number of medical professionals believe that the ESR should be eliminated since its results are often misleading and too nonspecific. Moreover other indicators of inflammation such as the C-reactive protein (CRP) and fibrinogen are now readily available to provide more reliable information. The ESR is also costly, labor intensive, and hazardous to laboratory personnel. Based on the above, Lahey Clinic Medical Center eliminated ESR testing in April of 2010. To accomplish this, an initial informational campaign was launched among the Lahey Clinic medical staff. Literature was distributed and face-to-face meetings were conducted with the most frequent users of the test. Details of the ESR's limitations and the suitability of its replacement by the CRP were emphasized. To strengthen the contention that ESRs are not essential to our institution, two in-house studies were performed: Study 1 reviewed 6 months of patient data from 2008 in order to evaluate cases where the CRP was negative and the ESR was positive. Study 2 used multiple regression analysis to show that ESR values could be calculated from, and presumably replaced by, other clinical data. Study 1: The table below shows that among 4,858 paired ESR/CRP results collected over 6 months there were 17 cases with markedly elevated ESRs (> 50) and normal CRPs (≤5). There were 5,944 unpaired ESRs for this period. Chart reviews of the 17 cases showed that the ESR provided no additional clinical value and, of note, 4 of the 17 patients did have elevated CRPs in the course of their illness. In Study 2, multiple regression analysis of 155 specimens identified 4 independent correlates of the ESR among 8 variables studied: Fibrinogen, Globulin, Hematocrit and Age (collective r2 = 0.85). The scatter plot in the figure displays the relation of the observed to the calculated ESRs.Table:Results of 4858 Paired CRP/ESR Tests over 6 Months in 2008ESRCRP≤20>20 ≤50>50TOTAL≤51830304172151>5 ≤10818326561200>104466144471507TOTAL309412445204858 In late 2009 a memo went out to our physicians giving three months notice of the ESR's discontinuation and recommending use of the CRP in its place. During this period, reminders of the approaching deadline were appended to all ESR results. For the Departments of Rheumatology and Infectious Diseases, an additional three months were granted during which time calculated ESR, fibrinogen, globulin, and hematocrit values were reported for every ESR ordered. In comparison to Study 1, the same six month period in 2011 shows a fall of 10,802 ESRs, a gain of 5,669 CRPs, and a drop in utilization of about 5,000 tests or 10,000 per year. These numbers suggest that CRPs replaced the unpaired ESRs and the utilization drop was due primarily to deletion of ESRs from paired orders. Over sixteen months of post ESR testing, the laboratory received only four inquiries from the medical staff: a complaint that a CRP did not automatically replace an ESR order; a request for supportive literature; and two requests for ESR values that were needed to satisfy standard treatment protocols. The latter were provided with calculated ESRs. In summary, ESR elimination occurred smoothly and with minimal incident. Sixteen months of experience have yielded no negative clinical effects but have produced the perceived benefits of utilization reduction, more available technologist time, less bio-hazard exposure, and elimination of an obsolete test. Disclosures: No relevant conflicts of interest to declare.

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3

Scattoni, Vincenzo. "Editorial Comment on: Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System: The Lahey Clinic Medical Center Experience and an International Meta-Analysis." European Urology 54, no. 2 (August 2008): 379. http://dx.doi.org/10.1016/j.eururo.2008.03.050.

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4

Montironi, Rodolfo, Liang Cheng, and Antonio Lòpez Beltran. "Editorial Comment on: Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System: The Lahey Clinic Medical Center Experience and an International Meta-analysis." European Urology 54, no. 2 (August 2008): 380–81. http://dx.doi.org/10.1016/j.eururo.2008.03.051.

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5

Danilov, Alexey V., Olga Danilova, Andreas Klein, Jennifer Brown, Arthur P. Rabinowitz, Kenneth B. Miller, and Brigitte T. Huber. "ZAP-70 Disrupts Dipeptidyl Peptidase 2 (DPP2)-Regulated Quiescence in Chronic Lymphocytic Leukemia (CLL)." Blood 114, no. 22 (November 20, 2009): 1251. http://dx.doi.org/10.1182/blood.v114.22.1251.1251.

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Abstract Abstract 1251 Poster Board I-273 CLL is a common hematologic malignancy with heterogeneous outcomes. Overexpression of ZAP-70 and unmutated B-cell receptor (BCR) heavy chain gene (IgVH) confer an adverse prognosis. While it is accepted that ZAP-70 augments BCR signaling in CLL B-cells, it remains unclear how ZAP-70 contributes to disease propagation. Peripheral blood CLL B-cells accumulate in G0. We have previously shown that CLL B-cells express DPP2, a serine protease involved in maintenance of quiescence of resting but not activated lymphocytes. We identified two subsets of CLL: sensitive CLL (S-CLL), where CLL B-cells undergo apoptosis upon inhibition of DPP2, and resistant CLL (R-CLL), where inhibition of DPP2 does not cause cell death. Here we sought to validate our preliminary observation and establish the role of ZAP-70 and BCR signaling in resistance to apoptosis in CLL. The patient cohort included 152 subjects with B-CLL from the Hematology clinics at Tufts Medical Center, Dana-Farber Cancer Institute (both in Boston, MA), and the Lahey Clinic (Burlington, MA). IgVH mutational status, ZAP-70 expression and history of treatment were analyzed. CLL B-cells were isolated from peripheral blood with standard Ficoll-Hypaque technique. Cells were treated with ValboroPro (VbP, Point Therapeutics), a non-specific inhibitor of DPPs, or AX8819 (ActivX), a DPP2-specific inhibitor. To interfere with ZAP-70, cells were treated with 17-Allylaminodemethoxygeldanamycin (17-AAG, Calbiochem), an inhibitor of hsp90, a protein involved in stabilization of ZAP-70. For apoptosis analysis cells were stained with propidium iodide and Annexin V at 16 h of incubation and assayed by flow cytometry. A CBA assay was used to measure tyrosine-phosphorylated p72Syk and ZAP-70. Expression of p27 and p130 proteins was assessed by western blot analysis. Of 152 CLL patients 99 were males (65.1%). Median age was 63 years. Median follow up was 6 years. When the study samples were obtained, 107 patients (70.4%) were untreated. In apoptosis assays, 97 (63.8%) samples were categorized as S-CLL and 55 (36.2%) as R-CLL. The small molecule inhibitor data correlated with DPP2 anti-sense experiments. Patients with R-CLL were more likely to receive treatment of their disease and had a shorter treatment-free interval from disease diagnosis compared with S-CLL (HR=4.79, 95% CI, 4.7 to 15.2; p<0.0001). In the R-CLL subgroup, B-CLL cells also exhibited unmutated IgVH and expressed high level of ZAP-70 (p<0.001). R-CLL B-cells exhibited higher level of p72Syk phosphorylation compared with S-CLL (p<0.05), suggesting that those cells are partially activated. Meanwhile, S-CLL B-cells had high p27 and p130 protein level, characteristic of a quiescent state. ZAP-70 was phosphorylated at a similar level between the two subsets, consistent with earlier observations that ZAP-70 does not depend on its phosphorylation to enhance BCR signaling. Upon inhibition of DPP2, S-CLL B-cells became activated as evidenced by dramatic phosphorylation of p72Syk. Concomitantly, p27 and p130 protein levels decreased indicating inappropriate cell cycle entry. Co-inhibition of DPP2 and hsp90 in R-CLL B-cells increased apoptosis by a mean of 8.1%, indicating that their survival is dependent on ZAP-70. CLL can be categorized into two prognostic groups based on the susceptibility of B-cells to DPP2 inhibition-induced apoptosis. Resistance to apoptosis correlates with unmutated IgVH and high ZAP-70 and is associated with an unfavorable disease course. The distinction between the two subsets of CLL stems from the aberration in the quiescence program. While S-CLL B-cells rest in true G0, R-CLL B-cells are partially activated due to ZAP-70 co-stimulatory signal and escape apoptosis. Destabilization of ZAP-70 reverses the resistant phenotype. DPP2 inhibition alone or with concomitant inhibition of ZAP-70 warrants investigation as a therapeutic modality in CLL. Disclosures No relevant conflicts of interest to declare.

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6

Morley, T. P. "Kenneth Edwin Livingston M.D., D.A.B.N., F.A.C.S., F.R.C.S. (C) (1914 – 1984)." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 12, no. 1 (February 1985): 76. http://dx.doi.org/10.1017/s0317167100046655.

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Kenneth Livingston was born in 1914 in Pendleton, Oregon. He attended Stanford University and obtained his BA in 1936. His medical student days were spent at Harvard where he graduated MD in 1939.His neurosurgical education began in 1942 at Strong Memorial Hospital, Rochester, N.Y.; then, after two years at the U.S. Naval Hospital in Oakland, California, he was appointed to the Attending Staff at the Lahey Clinic in Boston from 1946-1948. He returned to Oregon as Assistant Clinical Professor of Neurosurgery at the University of Oregon Medical School in 1948.

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7

Al Badi, Khalid Suidan. "Operation Management: Empirical Case Study (Al Buraimi Medical Clinic—Private Clinic)." Journal of Business Theory and Practice 3, no. 1 (March 6, 2015): 18. http://dx.doi.org/10.22158/jbtp.v3n1p18.

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<p><em>This case is about a “walk in” clinic called Al Buraimi Medical Clinic (BMC) which treats non-acute illnesses. BMC’s philosophy states “first come, first served”. It serves about 15,000 citizens. This is the only medical center in the region that provides some of the advanced services including a world-class rehabilitation center, regional burn center, high-risk maternity program and trauma center. This case describes how a process could affect the effectiveness and efficiency of a service. It’s vital to understand how process works as it helps to ensure the competitiveness of the company. A process according to Chase, Jacobs and Aquilano (2006), process is any part of the company that turns inputs into outputs which is of a more value to the company than the original inputs. In this case, nurses, MD, specialized equipments combined with another input, the patient is transformed through proper treatment and medical care into a healthy patient. Therefore, the healthy patient is an outcome of the process.</em><em> </em></p>

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8

Dorcely, Brenda, Michael Bergman, Craig Tenner, Karin Katz, Ram Jagannathan, and Elizabeth Pirraglia. "Manhattan Veterans Affairs Medical Center Diabetes Prevention Clinic." Clinical Diabetes 38, no. 3 (February 28, 2020): 291–94. http://dx.doi.org/10.2337/cd19-0085.

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9

Hansen, Moritz. "Maine Medical Center Cancer Institute's Prostate Cancer Clinic." Oncology Issues 24, no. 5 (September 2009): 24–32. http://dx.doi.org/10.1080/10463356.2009.11883452.

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10

Yurko, L. C., C. P. Brandt, T. L. Coffee, and C. J. Yowler. "Medical Center Utilization of an Outpatient Burn Clinic." Journal of Burn Care & Rehabilitation 23 (March 2002): S108. http://dx.doi.org/10.1097/00004630-200203002-00131.

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11

Cram, David Lee, Ann T. Maesner, and Douglas M. Witmore. "Medication Refill Clinics: The Veterans Administration Medical Center Experience." Journal of Pharmacy Practice 5, no. 1 (February 1992): 12–21. http://dx.doi.org/10.1177/089719009200500105.

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Medication refill clinics have been operating for about two decades. These clinics provide cost-effective and high-quality pharmaceutical care to patients who require refills on their medications. The following article describes one Veterans Affairs Medical Center's experience with a medication refill clinic. Guidelines for setting up a refill clinic are presented, including clinic development and justification, training of the practitioner, policies and procedures, and quality assurance management. Benefits of the clinic also will be discussed.

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12

Mantha, Simon, Ann M. Pianka, and Nicholas P. Tsapatsaris. "Determinants of Intracranial Hemorrhage Incidence in Patients on Oral Anticoagulation Followed at the Lahey Clinic." Blood 116, no. 21 (November 19, 2010): 1101. http://dx.doi.org/10.1182/blood.v116.21.1101.1101.

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Abstract Abstract 1101 Background: oral anticoagulation with warfarin is used to treat venous and arterial thromboembolic disease. Its administration is associated with a risk of intracranial hemorrhage (ICH), a devastating complication which usually results in death or severe disability. The international normalized ratio (INR) is one of the factors which can help determine the risk of ICH in a given individual (Singer DE et al, Circ Cardiovasc Qual Outcomes 2009). Materials and methods: using the DoseResponse® patient database at our institution, we carried out a retrospective nested matched case-control study to identify patient characteristics associated with the occurrence of ICH. The database was queried for the years 2007 to 2009. Each case was matched by month to 4 control patients having a routine INR determination for the monitoring of chronic anticoagulation. The following characteristics were captured: INR, age, sex, systolic and diastolic blood pressure, hemoglobin, creatinine, history of pertinent medical conditions (hypertension, diabetes, heart failure, gastrointestinal bleeding, ischemic stroke, active cancer, substance abuse, cirrhosis), indication for anticoagulation (non-valvular atrial fibrillation, valvular atrial fibrillation, venous thromboembolism or other) and intake of antiplatelet agent. Blood pressure for cases was obtained from a medical encounter occurring before the bleeding event. The relationship between those risk factors and the odds ratio of ICH was determined with conditional logistic regression, using the SAS® 9.2 software platform. The initial approach consisted of stepwise regression with forward selection and backward elimination. Results: 31 cases of ICH were retrieved; they were matched to 124 controls. In the univariate analysis, the two groups differed significantly only in terms of their hemoglobin: 12.8 versus 13.5 g/dL for cases and controls, respectively (p=0.048). As for the INR, the mean value was 3.0 for cases vs 2.5 for controls. The distribution of this parameter was normal albeit more markedly skewed to the right for cases, with 3 values of 5.0 or more, compared to only one instance of this for controls. Most cases of ICH occurred in the setting of a therapeutic INR. The odds ratio (OR) of ICH (using the interval 2.01 to 2.50 as the reference) started increasing above an INR of 3.50, reaching its highest level in individuals with an INR value greater than 4.50 (OR=5.78, 95% CI=1.10-30.48). Mean blood pressures were similar between the two groups: 92 vs 89 mmHg for cases vs controls, respectively (p=0.252). The variables retained in the final regression model on the basis of statistical significance and clinical pertinence are shown in the table. The OR of ICH was 1.50 for increments of 1.0 in INR value (p=0.021), while it was 1.56 for increments of 10 mmHg in mean blood pressure (p=0.032). The presence of cancer, anemia and heart failure appeared to contribute to the risk of an event but the associations for those factors were not statistically significant. Conclusion: the INR is an important predictor for the incidence of ICH, but a supratherapeutic measurement is found only in a minority of cases; the risk of an event increases markedly with an INR above 3.5. Mean blood pressure is another important determinant of the risk of ICH in individuals on chronic warfarin therapy. Previous studies have shown that a diagnosis of hypertension is associated with an increased risk of ICH in the anticoagulated patient population (Berwaerts J et al, QJM 2000; Atrial Fibrillation Investigators, Arch Intern Med 1994; Singer DE et al, Ann Intern Med 2009), but to the knowledge of this author there has been no report describing the variation in this risk over the spectrum of mean blood pressures. This lends support to the generally accepted practice of aggressively treating arterial hypertension in patients on chronic oral anticoagulation. Multivariable Analysis Disclosures: No relevant conflicts of interest to declare.

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Blanchet, Kevin D. "Clinic Profile: The Advocate Medical Group’s Center for Complementary Medicine." Alternative and Complementary Therapies 14, no. 3 (June 2008): 151–54. http://dx.doi.org/10.1089/act.2008.14307.

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14

Rapoport, Anna, and Hammam Akbik. "Pharmacist-managed pain clinic at a Veterans Affairs Medical Center." American Journal of Health-System Pharmacy 61, no. 13 (July 1, 2004): 1341–43. http://dx.doi.org/10.1093/ajhp/61.13.1341.

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15

Neumann, Melissa, Steven Keller, and Andrew Berman. "LUNG CANCER SCREENING IN A MEDICAL CLINIC IN AN URBAN ACADEMIC MEDICAL CENTER." Chest 158, no. 4 (October 2020): A1471. http://dx.doi.org/10.1016/j.chest.2020.08.1327.

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Gao, Rebecca W., Anisia Dugala, Janelle Maxwell, Patricia Falconer, Andrew C. Birkeland, Vasu Divi, and Eben L. Rosenthal. "Effect of Medical Scribes on Outpatient Oncology Visits at a Multidisciplinary Cancer Center." JCO Oncology Practice 16, no. 2 (February 2020): e139-e147. http://dx.doi.org/10.1200/jop.19.00307.

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PURPOSE: The use of medical scribes has emerged as a strategy to increase clinic workflow efficiency and reduce physician burnout. While oncology clinics may be ideally suited to scribe integration because of the high burden of documentation, oncology-specific scribe research has been limited. The objective of this study was to determine the effect of scribe integration on clinic workflow efficiency and physician satisfaction and quality of life in outpatient oncology clinics. METHODS: We conducted a retrospective, concurrent qualitative and quantitative analysis of patient visit durations and survey data for 129 attending physicians affiliated with an academic hospital’s cancer center between January 2017 and January 2019. Thirty-three physicians were paired with scribes in each physician’s individual clinic or clinics. RESULTS: In terms of clinic efficiency, physicians with scribes had a 12.1% decrease in their overall average patient visit duration compared with their own time before receiving a scribe ( P < .0001) and spent significantly less time completing charts at the end of the day ( P = .04). Compared with their peers, oncologists with scribes showed a 10%-20% decrease in the duration of all patient visits. Scribes also contributed to patient care, as shown by 90% of physicians surveyed who strongly agreed that they spent less time at the computer and more time with patients; 100% of physicians surveyed strongly agreed that scribes improved their quality of life. CONCLUSION: The integration of medical scribes into oncology clinics across several oncologic disciplines has the potential to reduce burnout through increasing physician satisfaction and quality of life, improving patient care, and streamlining clinic workflow.

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Shen, Le, Xin Zhang, Dawawuzhu, Labaciren, Yuelun Zhang, Zhonghuang Xu, and Yuguang Huang. "Pain Clinic in Tibet, China: A Single-Center Retrospective Study." Pain Research and Management 2019 (January 14, 2019): 1–4. http://dx.doi.org/10.1155/2019/9161906.

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Pain disease is a worldwide problem.The prevalence of chronic pain in developed and developing countries has been reported in some published research. However, little knowledge of situation of pain clinic in Tibet is known. Tibet Autonomous Region People’s Hospital established the first pain clinic in Tibet. This study collected and analyzed the data of medical records of pain clinic in Tibet Autonomous Region People’s Hospital from September 2017 to August 2018. The results showed that the total amounts of patients visiting pain clinic were very small, the most common pain diseases were postherpetic neuralgia and sciatica, and more female patients visited the pain clinic than male patients. All these results indicate that the hospital and government need to pay more attention to the development and promotion of pain medicine in Tibet to make Tibetans being accessed to high-quality pain clinic service.

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18

Luo, Jing, Yang Ming Qian, Sheng Xin Weng, and Huai Yong Li. "The Application of Digital Medical Technology in Maritime Medical Treatment." Advanced Materials Research 271-273 (July 2011): 324–29. http://dx.doi.org/10.4028/www.scientific.net/amr.271-273.324.

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The application of Digital Medical Technology in Navy fleet voyage is an effective means for medical treatment efficiency improvement, diagnosis capability enhancement, and realization of telemedicine at sea under special conditions. Through the establishment of remote medical center and the design of maritime telecommunications link, various biological data can be collected via technique such as sensors during the process of medical treatment at sea and transfer of the wounded. Hence, a synchronized maritime clinic data center is in place to allow for information exchange between the maritime treatment platform and the hospital on land. With the remote support of maritime medical center for treatment at sea, the advantages of flexibility, adaptability and reliability are clear. The application of digital medical technology in maritime medical treatment plays a significant role in enhancing the medical support capability.

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Cavanaugh, Jamie, Nicole Pinelli, Stephen Eckel, Mark Gwynne, Rowell Daniels, and Emily M. Hawes. "Advancing Pharmacy Practice through an Innovative Ambulatory Care Transitions Program at an Academic Medical Center." Pharmacy 8, no. 1 (March 12, 2020): 40. http://dx.doi.org/10.3390/pharmacy8010040.

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Hospital readmissions are common and often preventable, leading to unnecessary burden on patients, families, and the health care system. The purpose of this descriptive communication is to share the impact of an interdisciplinary, outpatient clinic-based care transition intervention on clinical, organizational, and financial outcomes. Compared to usual care, the care transition intervention decreased the median time to Internal Medicine Clinic (IMC) or any clinic follow-up visit by 5 and 4 days, respectively. By including a pharmacist in the hospital follow-up visit, the program significantly reduced all-cause 30-day hospital readmission rates (9% versus 26% in usual care) and the composite endpoint of 30-day health care utilization, which is defined as readmission and emergency department (ED) rates (19% versus 44% usual care). Over the course of one year, this program can prevent 102 30-day hospital readmissions with an estimated cost reduction of $1,113,000 per year. The pharmacist at the IMC collaborated with the Family Medicine Clinic (FMC) pharmacist to standardize practices. In the FMC, the hospital readmission rate was 6.5% for patients seen by a clinic-based pharmacist within 30 days of discharge compared to 20% for those not seen by a pharmacist. This transitions intervention demonstrated a consistent and recognizable contribution from pharmacists providing direct patient care and practicing in the ambulatory care primary care settings that has been replicated across clinics at our academic medical center.

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20

Provan, Helen, Vasilios Raftopoulos, and Elpidoforos Soteriades. "Use of Occupational Health Services in a Cyprus Oncology Center." AAOHN Journal 57, no. 5 (May 2009): 198–201. http://dx.doi.org/10.3928/08910162-20090416-03.

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Use of occupational health services in the hospital environment is an important parameter for annual health care planning. The objective of this study was to evaluate the clinic utilization at a Cyprus oncology center. All visits to the occupational health clinic during an 18-month period were reviewed and analyzed. During the study period, the center had, on average, 161 employees and offered 67 occupational health clinic sessions. Employees had 338 clinic visits, of which 294 were primary and 44 were follow-up visits, with 5 employees, on average, visiting the clinic at each session. Nurses most frequently visited the center (33.4%), followed by the administrative staff (28.6%) and the employees of the Medical Physics and Radiology Department (22.4%), corresponding to the largest groups of employees. The most frequently cited reason for the visits was administrative purposes (23.6%), including updating health records, followed by pre-placement examinations (14.7%) and vaccinations (10.3%). Administrative and clinical reasons were given for occupational health clinic use at the oncology center across all categories of employees.

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Provan, Helen, Vasilios Raftopoulos, and Elpidoforos Soteriades. "Use of Occupational Health Services in a Cyprus Oncology Center." AAOHN Journal 57, no. 5 (May 2009): 198–201. http://dx.doi.org/10.1177/216507990905700507.

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Use of occupational health services in the hospital environment is an important parameter for annual health care planning. The objective of this study was to evaluate the clinic utilization at a Cyprus oncology center. All visits to the occupational health clinic during an 18-month period were reviewed and analyzed. During the study period, the center had, on average, 161 employees and offered 67 occupational health clinic sessions. Employees had 338 clinic visits, of which 294 were primary and 44 were follow-up visits, with 5 employees, on average, visiting the clinic at each session. Nurses most frequently visited the center (33.4%), followed by the administrative staff (28.6%) and the employees of the Medical Physics and Radiology Department (22.4%), corresponding to the largest groups of employees. The most frequently cited reason for the visits was administrative purposes (23.6%), including updating health records, followed by pre-placement examinations (14.7%) and vaccinations (10.3%). Administrative and clinical reasons were given for occupational health clinic use at the oncology center across all categories of employees.

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Farrugia, G., and R. M. Weinshilboum. "Challenges in Implementing Genomic Medicine: The Mayo Clinic Center for Individualized Medicine." Clinical Pharmacology & Therapeutics 94, no. 2 (March 11, 2013): 204–6. http://dx.doi.org/10.1038/clpt.2013.52.

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23

Weis, Daniel R., and Gail H. Manos. "Prevalence and Epidemiology of Pathological Gambling at Naval Medical Center Portsmouth Psychiatry Clinic." Military Medicine 172, no. 7 (July 2007): 782–86. http://dx.doi.org/10.7205/milmed.172.7.782.

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24

Barnthouse, Maggie M., Jennifer M. Bjelich, Mrinalini Gadkari, and Mamta Reddy. "Value Stream Analysis of an Allergy Clinic in an Urban Academic Medical Center." Journal of Allergy and Clinical Immunology 139, no. 2 (February 2017): AB55. http://dx.doi.org/10.1016/j.jaci.2016.12.132.

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Perepu, Usha S., Amy M. Leitch, and Sundara Reddy. "Implementation of a Preoperative Anemia Management Clinic in a Tertiary Academic Medical Center." Blood 128, no. 22 (December 2, 2016): 1004. http://dx.doi.org/10.1182/blood.v128.22.1004.1004.

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Abstract Background: Preoperative anemia is commonly encountered with a reported incidence of 5-75% in elective presurgical populations. Anemia is an independent risk factor for perioperative morbidity and mortality and is a strong predictor of perioperative blood transfusion. Approximately 50% of all blood transfusions occur in the perioperative setting and transfusions are a significant financial burden for healthcare institutions. Although preoperative anemia management has been shown to reduce transfusion requirements and improve perioperative outcomes, the optimal delivery model for this service remains unclear. We describe the implementation of a novel preoperative anemia management clinic (AMC) workflow and report patient volume trends since its implementation in Jan 2015 at the University Of Iowa Hospitals & Clinics. Methods: We identified patients undergoing elective high blood loss (HBL) surgical procedures (defined as predicted blood loss >500 cc) with a preoperative hemoglobin (Hb) <12 g/dl as the target population for preoperative anemia management. We identified HBL procedures by ICD codes using information derived from our institutional maximum surgical blood-ordering schedule (MSBOS), intraoperative estimated blood loss (EBL) data from the electronic medical record (EMR) and surgical provider input. In calendar year 2014, 3262 elective HBL surgical patients were identified, out of which 452 (13.9%) received perioperative red cell transfusions. 232 (51.3%) of these patients had a preoperative Hb <12 g/dl. 61 (26%) of these patients were transfused 1 unit PRBCs, 62 (27%) were transfused 2 units and the remaining 109 (47%) patients were transfused > 2 units. Assuming 1- 2 unit transfusions were preventable by preoperative anemia managment, the calculated cost savings to the institution by avoiding these transfusions was estimated to be $200,000/year, not including potential improvement in length of stay. Using these data as baseline, a business plan for an AMC was presented to and approved by our hospital administration. An outpatient clinic was initiated in a temporaray location in early 2015 and later moved to a permanent location with infusion capabilities in August 2015 with two full time staff including a nurse practitioner and a medical assistant supervised by a nurse manager and a medical director. To streamline workflow, a stepwise algorithm for diagnosis and management of anemia was created by a multidisciplinary team that included Hematology, Anesthesiology, Surgery, Internal Medicine, Nursing and Pharmacy. We established referral mechanisms primarily from surgical clinics via automatic EMR alerts for elective HBL procedures linked to case scheduling through the EMR and secondarily through direct outpatient consultations. Results: We observed an overall trend of reduction in the percentage of patients transfused perioperatively in the two quarters following implementation of the preoperative AMC compared with the preceding quarterly intervals since Jan 2014 (Figure). In the same time period we observed a steady increase in number of patient visits to the AMC and number of iron infusions administered. Patient visits and iron infusions more than doubled in the first two quarters of 2016 compared to same time period in 2015 (594 vs 195 and 366 vs 124 respectively). There was a significant reduction in average length of stay (2.78 days) for patients who received transfusions after an AMC visit compared with patients who were not seen in the AMC. Conclusions: Implementation of a structured preoperative anemia management clinic (AMC) with an automatic referral workflow is feasible at a large academic medical center and appears to result in reductions in blood transfusions and hospital length of stay. The heterogeneity of our surgical population and the short timespan since implementation of the AMC are limitations of this analysis. We have ongoing efforts to minimize system errors in our referral mechanisms (ie appropriate EMR alerts to surgeons) and enhance surgical provider education to maximize preoperative anemia management opportunities. Disclosures No relevant conflicts of interest to declare.

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Dang, Stuti, Glen Baker, and David A. Lipschitz. "Financial Effect of a Hospital Outpatient Senior Clinic on an Academic Medical Center." Journal of the American Geriatrics Society 50, no. 10 (October 2002): 1621–28. http://dx.doi.org/10.1046/j.1532-5415.2002.50452.x.

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Walsh, T. Declan. "Continuing care in a medical center: The Cleveland Clinic Foundation palliative care service." Journal of Pain and Symptom Management 5, no. 5 (October 1990): 273–78. http://dx.doi.org/10.1016/0885-3924(90)90043-j.

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Jun, Jeany K. "Establishing Clinical Pharmacy Services With Prescribing Privileges in a Federally Qualified Health Center Primary Care Clinic." Journal of Pharmacy Practice 31, no. 5 (July 18, 2017): 434–40. http://dx.doi.org/10.1177/0897190017718752.

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Objectives: To describe the process and cost of establishing clinical pharmacy services with prescribing privileges in a federally qualified health center (FQHC) primary care clinic. Setting: The primary care clinic was located in a low-income area of Southern California and served patients with Medicaid and Medicare. The primary care clinic had preventive medicine and family medicine physicians, a family medicine residency program, behavioral health services, and a registered dietician. Practice Innovation: New clinical pharmacy services were established at this FQHC primary care clinic. The medication assistance program was a stepping stone to establish rapport with the physicians. Credentialing and privileging was implemented for clinical pharmacists. An open protocol collaborative practice agreement was developed to allow clinical pharmacists to manage ambulatory patients. Results: From August 2014 to June 2015, the clinical pharmacist interacted with 392 patients and spent 336 hours educating patients and providing disease state management. The pharmacist also provided consults to residents and providers. Diabetic patients made up 76% of all clinical pharmacy encounters. There were 86 face-to-face clinical pharmacy appointments with the pharmacist. The average time for clinical pharmacy appointments was 77 minutes. Conclusion: By describing ways to develop rapport with providers, how to credential and privilege pharmacists, and explain resources and costs of setting up a service, the hope is that more clinical pharmacists will be able to incorporate into independent or FQHC primary care clinics for improved management of ambulatory patients.

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Panchenkov, D. N., and Yu V. Ivanov. "SURGICAL CLINIC OF FEDERAL SCIENTIFIC CLINICAL CENTER FMBA OF RUSSIA: ON THE EDGE OF THE ACHIEVEMENTS OF MODERN SCIENCE AND PRACTICE." Journal of Clinical Practice 6, no. 3 (September 15, 2015): 20–29. http://dx.doi.org/10.17816/clinpract6320-29.

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The article is devoted to the surgical clinic, Federal scientific clinical center FMBA of Russia, its modern level. Presented new surgical techniques successfully implemented over the last 5 years (2011-2015) and widely used in the surgical clinic of Federal scientific clinical center FMBA of Russia. Emphasis is placed on the description of new minimally invasive technologies. Given the ongoing attention of the clinic staff, research and educational work. The results of surgical clinic clearly show that the close and fruitful collaboration between practicing surgeons, the staff and specialists from other medical institutions, is fully justified.

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Hatcher, Elizabeth, Farzana L. Walcott, Cam Ha, and April Barbour. "A centralized, primary care medical home survivorship model at the GW Cancer Center." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 45. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.45.

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45 Background: Models for survivorship care are often oncology-based. George Washington (GW) Adult Cancer Survivorship Clinic (ACS) has developed a unique, centralized model for survivorship care delivery staffed by internal medicine providers. The objective is to provide care to survivors that encompass the broad array of chronic issues they face, in addition to guidance on cancer surveillance and prevention. Methods: We implemented a centralized, primary care, consultative model of survivorship care, emphasizing care coordination. A personalized, evidence based survivorship care plan (SCP) is provided to each patient. Patients with complex needs may be seen for follow-up. A copy of the SCP is sent to the patient’s primary care provider (PCP). Referrals are made to our network of specialists within the GW system including: cardiology, neurology, weight management, genetic counseling, dermatology, physical therapy, integrative medicine, psycho-oncology, sexual health, and oncofertility. Referrals are tracked to specialty services using the electronic medical record (EMR). Results: Based on preliminary data, from January 2016 to October 2017, 261 cancer survivors were seen in the survivorship clinic. The majority were breast cancer survivors (166). Referral records were available for 225 patients. Most common were dermatology for baseline skin cancer screening (28%), physical therapy (16%), social work and psycho-oncology (15%), and weight management (15%). Conclusions: Our clinic is based on a primary care medical home model for each survivor, which includes care coordination and referral to specialty services. Limitations include inconsistent referral tracking methods with our EMR and incomplete data for all survivorship patients. Future research plans include assessing the impact of referrals on patient-reported outcomes and morbidity.

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Pang, Ran, Shihan Wang, Lin Tian, Mark C. Lee, Alexander Do, Susanne M. Cutshall, Guangxi Li, Brent A. Bauer, Barbara S. Thomley, and Tony Y. Chon. "Complementary and Integrative Medicine at Mayo Clinic." American Journal of Chinese Medicine 43, no. 08 (January 2015): 1503–13. http://dx.doi.org/10.1142/s0192415x15500858.

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Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

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Hudali, Tamer, Robert Robinson, and Mukul Bhattarai. "Reducing 30-Day Rehospitalization Rates Using a Transition of Care Clinic Model in a Single Medical Center." Advances in Medicine 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/5132536.

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Background. Rehospitalization for medical patients is common. Multiple interventions of varying complexity have been shown to be effective in achieving that goal with variable results in the literature. For medical patients discharged home, no single intervention implemented alone has been shown to have a sustainable effect in preventing rehospitalization. Objective. To study the effect of a transition of care clinic model on the 30-day rehospitalization rate in a single medical center. Methods. Retrospective observational analysis of adult patients discharged home from Memorial Medical Center from September 1, 2014, through December 31, 2014. The primary outcome was to compare hospital readmission rates between patients who followed up with a transition of care (TOC) clinic and those who did not. Results. The study population included 378 patient discharges. A total of 40 patients (10.6%) were readmitted to the hospital within 30 days of discharge. Patients who attended the TOC clinic had a significantly lower 30-day readmission rates (3.8% versus 11.7%). A Cox regression analysis showed that the TOC clinic attendance had a significant negative predication for readmission (HR 0.186, 95% CI 0.038–0.898, P=0.038). Conclusion. Adopting a TOC model after discharging medical patients has reduced the readmission rates in our study.

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Hixson-Wallace, Julie A., Beth Barham, Randell K. Miyahara, and Charles M. Epstein. "Pharmacist Involvement in a Seizure Clinic." Journal of Pharmacy Practice 6, no. 6 (December 1993): 278–82. http://dx.doi.org/10.1177/089719009300600604.

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The role of the clinical pharmacist in ambulatory care settings has expanded in the last several years. Various types of clinical pharmacy services in ambulatory clinics have been reported in the literature. This article seeks to describe the involvement of clinical pharmacists as primary-care givers in an outpatient neurology-seizure clinic of the Veterans Affairs Medical Center in Atlanta, GA. The Neurology-Seizure clinical pharmacy services are provided by faculty, residents, and students from Mercer University Southern School of Pharmacy. The faculty members have been granted clinical privileges to practice in the ambulatory clinics in order to function with authority to perform such duties as giving medication renewals, and writing in the medical chart. In the clinic itself, the pharmacist is responsible for providing a medication profile, an initial interview with the patient, a minor neurological examination, presentation of the patient to the attending neurologist, writing of a SOAP (subjective, objective, assessment and plan) note, an end-of-appointment consultation, completion of a clinic flow sheet, maintenance of the clinic record, follow-up phone calls relating the results of anti-epileptic drug levels, and monthly quality assurance summaries. Clinical pharmacist-supervised primary care outpatient clinics can be rewarding endeavors. Through close patient contact and interaction with attending physicians, pharmacists can greatly assist with pharmaceutical care and provide expert drug management of seizure patients.

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Fabbio, Kristin L., Matthew Bradley, and Margaret Chrymko. "Evaluation of a Pharmacist-Managed Telephone Lipid Clinic at a Veterans Affairs Medical Center." Annals of Pharmacotherapy 44, no. 1 (January 2010): 50–56. http://dx.doi.org/10.1345/aph.1m276.

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Silva Júnior, Ariovaldo Alberto da, Karina Viana Brandão, Bruno Engler Faleiros, Rafael Mattos Tavares, Rodrigo Pinto Lara, Eduardo Januzzi, Anísio Bueno de Carvalho, et al. "Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache." Arquivos de Neuro-Psiquiatria 72, no. 2 (February 2014): 99–103. http://dx.doi.org/10.1590/0004-282x20130221.

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Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. Objectives : To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Method : Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Results : Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001). Conclusion : TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

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Troiani, John S., Stanley M. Finkelstein, and Marshall I. Hertz. "Incomplete Event Documentation in Medical Records of Lung Transplant Recipients." Progress in Transplantation 15, no. 2 (June 2005): 173–77. http://dx.doi.org/10.1177/152692480501500211.

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Context The medical record is frequently used in clinical studies as a source of information on illness events experienced by patients; however, it may be incomplete. Objective To estimate the extent of incompletely documented acute bronchopulmonary events in a transplant clinic medical record at a single university medical center, using home monitoring data. Design, Setting, and Subjects Trends in daily home monitoring data were compared to contemporaneous medical record documentation at 150 different times in 30 lung transplant recipients over 45 subject-years. Outcome Measure Proportion of acute bronchopulmonary illness events documented in clinic medical record. Results By using home monitoring data in a new way, we found that 40% of events actually suffered by lung recipients could not be ascertained to have occurred from the clinic medical record alone. All missed encounters occurred away from the transplant clinic, and involved hospitalizations and telephone prescriptions. Conclusions Using the clinic medical record alone to identify acute bronchopulmonary events in lung transplant recipients may result in missing 40% of events. This has important ramifications for studies relying on the medical record for acute event ascertainment in lung transplantation and possibly other chronic diseases.

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Bing, Jung-Ho, Jae-Yoon Chun, Chang-Joo Park, Kyung-Gyun Hwang, and Kwang-Sup Shim. "Introduction of Sedation Clinic at Department of Dentistry in Hanyang University Medical Center (I)." Journal of the Korean Dental Society of Anesthesiology 6, no. 2 (2006): 113. http://dx.doi.org/10.17245/jkdsa.2006.6.2.113.

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Chun, Jae-Yoon, Jung-Ho Bing, Chang-Joo Park, Kyung-Gyun Hwang, and Kwang-Sup Shim. "Sedation at Sedation Clinic of Department of Dentistry in Hanyang University Medical Center (II)." Journal of the Korean Dental Society of Anesthesiology 7, no. 1 (2007): 13. http://dx.doi.org/10.17245/jkdsa.2007.7.1.13.

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Hough, Augustus, Christine M. Vartan, Julie A. Groppi, Sonia Reyes, and Nick P. Beckey. "Evaluation of clinical pharmacy interventions in a Veterans Affairs medical center primary care clinic." American Journal of Health-System Pharmacy 70, no. 13 (July 1, 2013): 1168–72. http://dx.doi.org/10.2146/ajhp120514.

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O'Connor, R. Corey, Merle Orr, Karen Rauen, Kathleen Sawin, and William P. Waring. "TRANSITIONING SPINA BIFIDA PATIENTS FROM A MULTIDISCIPLINARY PEDIATRIC CLINIC TO AN ADULT MEDICAL CENTER." Journal of Urology 179, no. 4S (April 2008): 297. http://dx.doi.org/10.1016/s0022-5347(08)60866-6.

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Sulistyaningsih, T., Siswanto, and Pangadi. "Petri Net Model and Max-Plus Algebra on Queue in Clinic UNS Medical Center." Journal of Physics: Conference Series 1494 (March 2020): 012004. http://dx.doi.org/10.1088/1742-6596/1494/1/012004.

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Shah, Mansi, Anna Markel Vaysman, and Lori Wilken. "Medication therapy management clinic: perception of healthcare professionals in a University medical center setting." Pharmacy Practice (Internet) 11, no. 3 (August 2013): 173–77. http://dx.doi.org/10.4321/s1886-36552013000300008.

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Fitzpatrick, C. C., J. O. L. DeLancey, T. E. Elkins, and E. J. McGuire. "Experience of a combined gynecology/urology clinic in the University of Michigan Medical Center." International Urogynecology Journal 5, no. 3 (June 1994): 160–63. http://dx.doi.org/10.1007/bf00386629.

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Neubauer, Marcus A., Melissa Jameson, Kathryn Eagye, Mitra Abdullahpour, Michael A. Kolodziej, Maria Sipala, Amy Supraner, and J. Russell Hoverman. "Patient support call center: Interaction with the oncology clinic." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 84. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.84.

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84 Background: Cancer patients receiving chemotherapy can become ill, often leading to hospitalization, adding huge costs to care. This is especially true with older cancer patients. Innovent Oncology (IO), an oncology disease management program, and Texas Oncology (TO) are conducting a novel program, funded by Aetna. Patients who begin IV chemotherapy are called by an IO nurse, working remotely, but with access to TO’s Electronic Medical Record. If the call center nurse detects a concern she notifies the practice. IO then tracks the action taken by the practice. We report on the incidence of practice notification, intervention that occurred, and incidence of hospitalization within 7 days of practice contact. Methods: This pilot program enrolls patients of Medicare age (Aetna Medicare Advantage members). Intervention calls (IC) to the practice are made at the discretion of the IO nurse. We identified all IC’s made from June 2013 to June 2015. We then categorized the actions taken by the practice and report on the four most common actions. IO receives a daily file from Aetna with hospital data. We looked at hospitalizations within 7 and 14 days from the IC. Results: 430 patients were enrolled over the above time period. 164 had at least one IC (215 total); 38% of patients had at least one IC. The four most common actions taken by the practice were: new medication prescription (N = 128); education over the phone (76); office visit within 24 hours (45); lab work ordered (22). 14 patients were admitted within 7 days of IC and 18 (inclusive of the 14) admitted within 14 days of IC. Conclusions: The IC’s are made when the IO nurse detects a problem during telephonic outreach. Therefore, this group of patients is at some risk for deterioration. Out of 215 IC’s made, 14 patients were admitted within 7 days of the call. We believe this number is low in this Medicare-age population and the results are promising. We believe the coordination between the patient support nurse and the clinic is partly responsible. This is a novel program so we can’t compare the IC/hospitalization rate to other data bases but, at the least, we can use this as a baseline going forward.

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Ali, Khawla F., Alexandra Mikhael, Christine Zayouna, Omar A. Barakat, James Bena, and M. Cecilia Lansang. "MEDICAL TOURISM AND DIABETES CARE: EXPERIENCE FROM A TERTIARY REFERRAL CENTER." Endocrine Practice 26, no. 10 (October 2020): 1125–30. http://dx.doi.org/10.4158/ep-2020-0054.

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Objective: Medical tourism, a form of patient mobility across international borders to seek medical services, has gained significant momentum. We aimed to assess the outcomes of medical tourism consultations on chronic diseases, more specifically diabetes mellitus, amongst a cohort of international patients, originating from different healthcare systems, and referred to the United States for medical care. Methods: We identified international adults with established diabetes mellitus, referred globally from 6 countries to the United States between 2010 and 2016 for medical care, and were seen at the Cleveland Clinic Foundation (CCF). Group 1 included adults seen by an endocrinology provider during their CCF medical stay, whilst group 2 included those not seen by an endocrinology provider. To assess the impact of our consultations, changes in hemoglobin A1c (HbA1c) were assessed between visit(s). Results: Our study included 1,108 subjects (771 in group 1, 337 in group 2), with a mean age (± SD) of 61.3 ± 12.7 years, 62% male, and a median medical stay of 136 days (interquartile range: 57, 660). Compared to group 2, group 1 had a higher baseline mean HbA1c (8.0 ± 1.8% [63.9 mmol/mol] vs. 7.1 ± 1.4% [54.1 mmol/mol]; P<.001). After 1 visit with endocrinology, there was a significant decrease in mean HbA1c from 8.44 ± 1.98% (68.3 mmol/mol) to 7.51 ± 1.57% (58.5 mmol/mol) ( P<.001). Greatest reductions in mean HbA1c were −1.47% (95% CI: −2.21, −0.74) and −1.27% (95% CI: −1.89, −0.66) after 3 and 4 visits, respectively ( P<.001). Conclusion: Short-term diabetes mellitus consultations, in the context of medical tourism, are effective. Abbreviations: CCF = Cleveland Clinic Foundation; GCC = Gulf Cooperation Council; HbA1c = hemoglobin A1c; IQR = interquartile range; U.S. = United States

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Szewczyk, Michael T., and Scott A. Soefje. "Development of an innovative delivery system for bacillus Calmette-Guérin bladder administration." American Journal of Health-System Pharmacy 78, no. 1 (October 22, 2020): 60–64. http://dx.doi.org/10.1093/ajhp/zxaa339.

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Abstract Purpose To describe the development of an innovative process to deliver bacillus Calmette-Guérin (BCG) to an offsite urology clinic for bladder instillation. Summary The use of BCG, a live virus vaccine for treatment of patients with localized cancer of the urinary bladder, has created many logistical problems for hospitals and infusion center pharmacies. Due to its short stability, the drug cannot be made ahead of time and coordination with a patient’s arrival at an infusion site is challenging. This becomes exceptionally challenging when a urology clinic has limited compounding capacity and/or is distant from the site of BCG medication preparation. This article describes an innovative process involving use of closed-system transfer devices (CSTDs) to allow for the administration of BCG in a urology clinic offsite from a medical center’s infusion center facilities. Conclusion The use of the CSTD allowed the patients to continue to receive bladder instillations at an offsite urology clinic without significantly disrupting compounding workflow at the small infusion center pharmacy that was the nearest to the clinic.

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Lin, Ming-Hwai, Hsiao-Ting Chang, Tzeng-Ji Chen, and Shinn-Jang Hwang. "Why people select the outpatient clinic of medical centers: a nationwide analysis in Taiwan." PeerJ 8 (August 27, 2020): e9829. http://dx.doi.org/10.7717/peerj.9829.

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Introduction In contrast to other countries, Taiwan’s National Health Insurance (NHI) program allows patients to freely select the specialists and tiers of medical care facility without a referral. Some medical centers in Taiwan receive over 10,000 outpatients per day. In the NHI program, the co-payment was increased for high-tier facilities for outpatient visits in 2002, 2005, and 2017. However, the policies only mildly reduced the use of high-tier medical care facilities. The main purpose of this study was to evaluate the factors contributing to the patients’ selection of the outpatient clinic of medical centers without a referral. Methods An online anonymous survey was conducted by using the Google Forms platform utilizing a self-constructed questionnaire from September to October 2018. A nationwide sample in Taiwan was recruited using convenience sampling through social media. Based on a literature review and a focus group, 20 factors that may affect the choice of the outpatient institution were constructed. The associations between items that affect the patients selection of outpatient clinics were assessed using exploratory factor analysis. Principal axis factoring was performed to identify the major factors affecting the decision. Multiple logistic regression was performed to determine which factors satisfactorily explained “visiting the outpatient clinic of the medical center for an illness without a referral.” Results During the survey period, 5,060 people browsed the online survey, and 1,003 responded and completed the online questionnaire. Therefore, the response rate was 19.8%. A total of 987 valid responses was collected. Exploratory factor analysis revealed that three main factors, namely the “physician factor”, “image and reputation factor”, and “facility and medication factor”, affected the selection of outpatient clinics. A series of logistic regressions indicated that patients who reported that hospital facilities, high-quality drugs, and diverse specialties were very important were more likely to select the outpatient clinic of a medical center (OR = 2.218, 95% CI [1.514–3.249]). Patients who reported that physician factors were very important were less likely to select a medical center (OR = 0.717, 95% CI [0.523–0.984]). Patients who were previously satisfied with their experience of the primary clinics or had a regular family doctor were less likely to choose a medical center (OR = 0.509, 95% CI -0.435–0.595] and OR = 0.676, 95% CI [0.471–0.969]). Conclusion In Taiwan, patients with good primary medical experience and regular family physicians had significantly lower rates by selecting the outpatient clinic of a medical center. The results of this study support that the key to establishing graded medical care is to prioritize the strengthening of the primary medical system.

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DeRemer, Christina E., Bliss McMichael, and Henry N. Young. "Warfarin Patients With Anemia Show Trend of Out-of-Range International Normalized Ratio Frequency With Point-of-Care Testing in an Anticoagulation Clinic." Journal of Pharmacy Practice 32, no. 5 (April 11, 2018): 499–502. http://dx.doi.org/10.1177/0897190018768114.

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Introduction: Many factors influence international normalized ratio (INR); however, few studies have examined the impact of anemia in warfarin patients. The primary objective of this study was to explore the relationship between in-clinic anemia and the control of INR within an anticoagulation clinic. Methods: A retrospective chart review was performed on a random sample of patients seen in an academic medical center pharmacy-managed anticoagulation clinic. Hemochron® Signature Elite machine was utilized to monitor point-of-care (POC) INR. In-clinic anemia was defined as hematocrit <32%. Statistical analyses were conducted using STATA MP a webbased platform ( https://www.stata.com/statamp/ ). Results: Of the 300 patients analyzed, 45 (15%) patients had in-clinic anemia. Patients with in-clinic anemia were more likely to be younger ( P < .05), female ( P < .05), and have a diagnosis of sickle cell disease or anemia ( P < .05). In the unadjusted logistic regression model, patients with in-clinic anemia were less likely to have an in-range INR ( OR: 0.52; 95% CI: 0.27-0.98). The adjusted regression model did not show significance. Conclusion: Study results suggest that in-clinic anemia may be more prevalent among younger, female patients prescribed warfarin, and patients diagnosed with in-clinic anemia may be a risk factor for out-of-range INR. Pharmacists practicing in anticoagulation clinics can incorporate this information into patient care practice in efforts to maintain optimal management.

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Gortakowski, Michele, and Chelsea C. Gordner. "Development of Repository From a Pediatric Gender Clinic." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A797. http://dx.doi.org/10.1210/jendso/bvab048.1621.

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Abstract Objectives: With the publication of updated guidelines for care of transgender and gender non-conforming individuals, there has been an increase in the presence of gender diversity in both mainstream media and medical literature. Several gaps currently exist in medical knowledge regarding long term effects of gender-affirming therapies. There is a lack of standardization in study design, patient sampling, and outcome measures, and most studies are retrospective. Here we describe the creation of both a retrospective and prospective repository of patients who presented to the Massachusetts Medical School-Baystate Medical Center (UMass-Baystate) pediatric gender program. Methods: Baystate Medical Center is located in western MA and is a tertiary referral center. A pediatric gender clinic was created in 2014. A repository containing both retrospective and prospective data was approved by the UMass-Baystate IRB to include patients ages 2 to 24 years of age who presented to our gender clinic. Retrospective data was obtained using the McKesson billing database. Sociodemographic, clinical and behavioral health data were collected. We are consenting individuals as they present to the clinic for the prospective component. Those that have consented fill out a survey at each visit. The repository has been approved to follow outcome data for 25 years. Results: To date, we have 218 individuals in the repository, 75 of which are in the prospective component. Age of presentation ranged from 6 yrs to 24 yrs with an average age of 15 yrs. 62% identified as transmale, 31% as transfemale and the remainder as gender fluid or other. 75% have been prescribed gender affirming hormone therapy (56% GnRH agonist therapy, 20% estrogen, 58% testosterone). Of those being followed prospectively, 76% identified as white, 19% Hispanic. 79% were satisfied or very satisfied with their care. Conclusions: Here we describe the demographic and clinical characteristics of patients that have presented to our gender clinic since 2014. The creation of our gender repository will allow us to assess sociodemographic, clinical and behavioral health outcomes of treatment, including metabolic parameters, bone health, and mental health outcomes in our pediatric population. Future projects include assessment of the change in cardiovascular risk in individuals on gender-affirming hormone therapy.

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Yakubov, V. I. "Features of the ovarian cancer clinic in postmenopausal women." Kazan medical journal 66, no. 2 (April 15, 1985): 138–39. http://dx.doi.org/10.17816/kazmj60920.

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Abstract:

The results of studying the history and symptoms of ovarian cancer depending on the state of menstrual function in 347 patients treated at the All-Russian Scientific Center of the Academy of Medical Sciences of the USSR from 1965 to 1982 are presented.

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