COVID-19 Collaborative Model for an Academic Hospital and Long-Term Care Facilities.

The COVID-19 pandemic is devastating post-acute and long-term care (PA/LTC). As geriatricians practicing in PA/LTC and a regional academic medical center, we created this program for collaboration between academic medical centers and regional PA/LTC facilities. The mission of the Geriatric Engagement and Resource Integration in Post-Acute and Long-Term Care Facilities (GERI-PaL) program is to support optimal care of residents in PA/LTC facilities during the COVID-19 pandemic. There are 5 main components of our program: (1) Project ECHO; (2) nursing liaisons; (3) infection advisory consultation; (4) telemedicine consultation; and (5) resident social contact remote connections. Implementation of this program has had positive response from our local PA/LTC facilities. A key component of our program is our interprofessional team, which includes physicians and nursing, emergency response, and public health experts. With diverse professional backgrounds, our team members have created a new model for academic medical centers to collaborate with local PA/LTC facilities.

Association between Clostridioides difficile infection and multidrug-resistant organism colonization or infection among hospitalized adults: A case-control study.

Using an ambidirectional case-control study, we found that the odds of Clostridioides difficile infection (CDI) were 3.38 (P = .01) times higher for patients with multidrug-resistant organism (MDRO) colonization compared to those without. MDRO colonization or infection 1-12 months before CDI testing significantly increased risk of positive CDI diagnosis (odds ratio 4.71, P = .02 and odds ratio = 5.03, P = .05, respectively) independent of antibiotic use, age, and comorbidity status. MDRO colonization and infection are associated with CDI, most significantly if they precede CDI.

Demographic and clinical characteristics of dominican adults admitted to a diabetic foot clinic in the Dominican Republic, 2015.

AIM: To identify the demographic and clinical characteristics of Dominican adults admitted to a diabetic foot clinic and compare these characteristics by sex to better characterize and understand the severity of diabetes in the Dominican Republic. METHODS: We conducted a retrospective medical chart review of Dominican adults admitted to the National Institute of Diabetes, Endocrinology, and Nutrition's (INDEN) diabetic foot clinic between January 1st, 2015 and December 31st, 2015. We generated descriptive statistics and compared results by sex. RESULTS: We assessed 447 medical charts of patients admitted in 2015. More men visited the clinic than women (65% vs. 35%). The average duration of diabetes was 14.4 ±â€¯8.9 years. Abscess was the most common foot problem (74% in men, 68% in women, p = 0.164). A slightly smaller proportion of men received amputations than women (46% vs. 51%, p = 0.390). Women were older (p < 0.001), less educated (p = 0.004), and less likely to be married (p < 0.001). Women also exhibited higher rates of obesity (p = 0.003), hypertension (p = 0.005), cardiovascular disease (p = 0.011), ischemic foot (p = 0.008), and above the knee amputations (p = 0.002). CONCLUSION: Implementation of diabetes education programs, introduction of proper foot care, and improved resources for lifestyle management are needed to increase awareness and subsequently decrease diabetes and its negative impact on the health and economy of the Dominican Republic. Our findings suggest that various risk factors and comorbidities important to the development of diabetes may be disproportionately affecting women. Interventions should focus on women and their behaviors that increase risk for diabetes.

Hormone replacement therapy after treatment for cervical cancer: Are we adhering to standard of care?

OBJECTIVE: The aim of this study was to assess hormone replacement therapy (HRT) and bone care health maintenance practices for cervical cancer patients with iatrogenic menopause, and, secondarily, to investigate the potential impact of specific demographic and clinical factors. METHODS: Women diagnosed with iatrogenic menopause due to cervical cancer treatment between January 1, 2005 and December 31, 2015 were identified from the University of Virginia's tumor registry. Univariable data were analyzed using Wilcoxon rank sum, Chi square, and Fisher's exact test; multivariable analysis was conducted using logistic regression. RESULTS: Two hundred and two women were included for analysis. Ninety-seven of these women (48.0%) received counseling and/or a prescription for HRT. After multivariable analysis, older age at diagnosis (adjusted OR 0.940, 95% CI 0.890-0.993, p=0.0270) and uninsured payer status (adjusted OR 0.455, 95% CI 0.212-0.977, p=0.0435) were associated with a decreased likelihood of receiving counseling or a prescription for HRT. A longer duration of follow-up was associated with the primary outcome with an adjusted OR of 1.011 (95% CI 1.001-1.020, p=value 0.0252). Dual-energy X-ray absorptiometry scans (DEXA) were infrequent and received by only 17/197 (8.6%) of all women. CONCLUSIONS: Fewer than half of all women received counseling and/or a prescription for HRT after diagnoses of iatrogenic menopause, and disparities were noted based on insurance status. These findings reflect a need for clearer guidelines on HRT during survivorship and improved efforts to reduce disparities in the distribution of survivorship care.