LAC+USC Medical Center

About: LAC+USC Medical Center is a healthcare organization based out in Los Angeles, California, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 1348 authors who have published 886 publications receiving 21927 citations. The organization is also known as: County/USC & Los Angeles County General.

Impact of adherence goal awareness intervention on PDC in various settings: Does awareness help modify medication-taking behavior?

Abstract: Background Interventions to improve medication adherence in chronic conditions have shown limited success or sustainability. Previous data revealed that phone calls to patients regarding adherence goal awareness resulted in significant improvement in proportion of days covered (PDC). Objectives The objective of this study was to explore specific pharmacist adherence interventions via phone in various practice settings. Methods A prospective, randomized controlled study was conducted with patients who belonged to university-associated health care settings [ambulatory care, chain store, small health plan, and federally qualified health center (FQHC)]. At each site, patients with at least one chronic medication and a calculated PDC Results Data from a total of 241 patients were pooled to examine change in PDC. There was no significant difference between groups in baseline criteria or PDC. Comparing within groups, there were significant correlations between Pre- and Post-PDCs for the intervention group (X = 0.32 p Conclusions Results suggested that patient adherence behavior may improve after any call made by pharmacy staff. This communication and attention from the pharmacy may be enough for patients to consider their medication-taking habits without the need for discussing specific goals and importance of adherence.

Pay It Forward

Abstract: For the past 3 years, I have served as a mentor for 24 medical students, a cohort of the first-year class at a medical school in Southern California. On Monday afternoons we meet in their MDL, or Multidisciplinary Lab, where we follow a curriculum designed to foster professional development, providing exposure to topics as varied as medical ethics, complementary and alternative medicine, or the role of the physician in society. The transformation of medical students into medical professionals is a complex process that involves numerous developmental stages occurring at largely unpredictable rates and manifesting over the career of a physician.1 This intricate process, balanced on so many fulcra, is inevitably influenced by forces that may seem unrelated, remote, or even insidious. Take something away here, and the effects may be felt in many different areas at once, some seen, some unseen, some evident only over time. Seeking to teach such a complex set of skills and attitudes is therefore an ever-evolving challenge. Consider then the skill set required of faculty who, like me, teach these courses never having taken a professionalism course in their own medical school experience; and that faced by medical educators charged with pinning professionalism down with their arsenal of goals and objectives. Despite these nuances, or maybe as a result of them, I find myself on these Monday afternoons transported to my own experiences starting out in this profession. At its core, the medical school journey itself has remained unchanged, even across continents, time zones, and decades. One aspect I find jarring is that the medical students I mentor are familiar with a very small number of their classmates, limited to those with whom they interact during class. They may have seen each other in lecture halls and the quad, but may never have spoken. Add to that the convenient and admittedly more effective method of webcasting lectures off campus, and most students can find themselves in the company of their peers maybe twice a week on most weeks. This contrasts starkly with my own experience of medical school. The campus was always abuzz; every student knew students in every class, and the fallow times between classes or at lunch were likely spent shooting the breeze, talking about the timeless topics that only medical students have ever talked about, and laying down the bonds for relationships that have come to be foundational in their scope. Most mundane problems found their solutions long before ever arriving at the dean’s desk, resources were cobbled together from the most unlikely sources in times of crisis, and we learned that we all sank or swam on the power of each other’s strengths and weaknesses. This is not to imply that one system is more desirable than the other or that students no longer bond with their peers. Only that now more than ever I see the value inherent to that particular experience. We didn’t realize it then, but we had formed ourselves organically into a community. This was in essence the backdrop against which professional formation had occurred in the days before professionalism courses. Imperfect and highly variable though it was, the process of forming a community, and defining and molding its central ethos during the medical school years, was one of the first forays into professional identity formation that a medical student made. How else were we to feel beholden to the greater community of medicine if we didn’t feel responsible toward each other? How else did we learn to work together if not through the conflicts and struggles that can only arise when the stakes are high and the pressure immense, much like it is in an emergency department or operating theater, or during examination week? A foundation of trust is essential to fostering the necessary emotional engagement that kick-starts the professional growth of medical students. Understanding the behavioral nuances of medical practice, learning what is and is not acceptable, is only possible when a trusted peer nudges you toward the more worthy choice, or the majority expresses disapproval to one of their own who failed to represent them well. In essence, the medical school community represents in microcosm the greater community of the profession. In which case it becomes fair to ask whether we have jettisoned this laboratory experience of professionalism formation without acknowledging its value. And if so, have we considered the consequences? I believe this sense of belonging to a community, and as a consequence to the greater society of physicians, is an essential fulcrum of the professionalism journey that has subtly shifted in recent times. I surmise that we are already starting to see the effects of this shift, with a widening rift of values between the generations, the disconnect between educators and their students, and the fact that current graduates define the central tenets of professionalism vastly differently from their teachers.2 Some of this is, of course, a result of the necessary progresses molded by society, technology, resources, time, and a burgeoning curriculum that seems to grow exponentially every year. When we talk about the challenges of generational differences, the fragmentation of health care, or the necessity of creating teams in the era of duty hours, we are in essence struggling to define the various aspects of what it means to be a medical professional in our time. A PIECE OF MY MIND

Evaluation of breast disorders with ultrasound.

Abstract: A 45-year-old nonlactating female presented to the emergency department (ED) fast-track area with a chief complaint of breast pain associated with redness. The symptoms occurred over a period of weeks. There were no constitutional symptoms of fever, chills, or weight loss. The patient had no known personal or family history of breast cancer. On physical examination, there was a 6- by 3-cm confluent area of erythema involving both lower quadrants of the breasts without dimpling. There were no palpable masses, areas of fluctuance, or discharge expressed from the areola. However, it was notable that the patient had large nonaugmented breasts that were difficult to examine. These findings were thought to be most consistent with infectious mastitis, and the patient was started on antibiotics for observation in the ED. On reexamination of the patient, given the difficulty of direct manual evaluation, ultrasound of the breast was performed with a high-frequency linear array ultrasound probe. A 4- by 4-cm complex structure with both solid and cystic components was visualized 1 cm below the area of erythema (see Movie Clip, online only). The patient was then admitted for evaluation of possible breast cancer versus deep tissue abscess. Initial fine-needle aspiration biopsy revealed diffuse lymphocytic invasion that was nonspecific. However, a later ultrasound-guided core-needle biopsy revealed infiltrating ductal carcinoma. Distinguishing between breast pathologies, such as simple infectious mastitis, breast abscess, or a malignant condition, can be quite challenging in the ED. A recent study of 127 adult mastitis complaints revealed that only 25% actually represented true simple infectious mastitis. Another 40% were found to be an abscess, and 6% represented a malignant condition.1 Currently, there is a growing body of literature that identifies ultrasound as being a more sensitive modality in identifying more complicated conditions, such as malignancy, from simple mastitis.2–3 Mammography, while more specific, is often difficult to obtain from the ED. Furthermore, the National Comprehensive Cancer Network endorses ultrasound alongside mammography as a class IIA screening modality for breast cancer with breast skin changes in their 2010 guidelines.4 This case demonstrates that the potential use of bedside ultrasound by emergency physicians can be a rapid and helpful diagnostic tool in differentiating an uncomplicated infectious condition, mastitis, from more complex pathology, such as breast cancer, that was ultimately diagnosed in this patient.

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

Abstract: The purpose of this study was to compare therapeutic strategies and outcomes, following isolated gunshot wounds of the head, between military and civilian populations.Recent military conflicts introduced new concepts in trauma care, including aggressive surgical intervention in severe head trauma.This was a cohort-matched study, using the civilian Trauma Quality Improvement Program (TQIP) database of the American College of Surgeons (ACS) and the Department of Defense Trauma Registry (DoDTR), during the period 2013 to 2016. Included in the study were patients with isolated gunshots to the head. Exclusion criteria were dead on arrival, civilians transferred from other hospitals, and patients with major extracranial associated injuries (body area Abbreviated Injury Scale >3). Patients in the military database were propensity score-matched 1:3 with patients in the civilian database.A total of 136 patients in the DoDTR database were matched for age, sex, year of injury, and head Abbreviated Injury Scale with 408 patients from TQIP. Utilization of blood products was significantly higher in the military population ( P <0.001). In the military group, patients were significantly more likely to have intracranial pressure monitoring (17% vs 6%, P <0.001) and more likely to undergo craniotomy or craniectomy (34% vs 13%, P <0.001) than in the civilian group. Mortality in the military population was significantly lower (27% vs 38%, P =0.013).Military patients are more likely to receive blood products, have intracranial pressure monitoring and undergo craniectomy or craniotomy than their civilian counterparts after isolated head gunshot wounds. Mortality is significantly lower in the military population.Level III-therapeutic.