UCLA Hospital Research Articles

Creating a standard inpatient opioid withdrawal protocol.

Background: Despite safety and efficacy of medications for opioid use disorder, United States (US) hospitals face high health care costs when hospitalized patients with opioid use disorder (OUD) leave due to untreated opioid withdrawal. Recent studies have concluded that evidence-based interventions for OUD like buprenorphine are underutilized by hospital services. Objective: We developed a practical opioid withdrawal protocol utilizing buprenorphine and the Clinical Opiate Withdrawal Scale to address opioid withdrawal during inpatient treatment of a primary medical condition. We are currently implementing this protocol at the UCLA hospital in Santa Monica. Design: The protocol includes order sets with appropriate and modifiable orders that can be submitted in the electronic medical record in order to deliver seamless care for opioid withdrawal. After the physician assesses the patient and initiates the protocol, nursing provides an essential role in continuing to monitor the patient's level of withdrawal and administering the appropriate medications in response. Inpatient pharmacy is instrumental in monitoring medication administration, as well as calculating and providing dosages for orders on Day 2 and 3 of the protocol. Collaboration with case managers is essential for providing appropriate resources and ensuring a safe discharge. Conclusion: Current challenges to widespread implementation of a standardized withdrawal protocol are discrepancies in addiction education across medical disciplines and inadequate outpatient access to buprenorphine providers and pharmacies that carry buprenorphine supplies.

Loneliness and mental well-being in the Polish population during the COVID-19 pandemic: a cross-sectional study

ObjectiveThere is a growing concern that the restrictions imposed due to the COVID-19 pandemic could lead to increased loneliness and mental disorders, which are considered a major public health problem....

Handshaking forbidden in hospitals

Handshaking forbidden in hospitals. The handshake may transmit infectious organisms. The transfer of microorganisms during usual forms of greetings (high five, fist bump and handshake with variable duration and pressure) was measured indicating that the fist bump is the safer form of greeting. A handshake-free zone was implemented in UCLA hospital and supported by healthcare professionals and parents of babies admitted to the Neonatal Intensive Care Unit.

Chaplain rounds: a chance for medical students to reflect on spirituality in patient-centered care.

This study assesses the perceived impact of a required half-day with a hospital chaplain for first-year medical students, using a qualitative analysis of their written reflections. Students shadowed chaplains at the UCLA hospital with the stated goal of increasing their awareness and understanding of the spiritual aspects of health care and the role of the chaplain in patient care. Participation in the rounds and a short written reflection on their experience with the chaplain were required as part of the first-year Doctoring course. The qualitative analysis of reflections from 166 students using grounded theory yielded four themes: (1) the importance of spiritual care, (2) the chaplain's role in the clinical setting, (3) personal introspection, and (4) doctors and compassion. Going on hospital rounds with a chaplain helps medical students understand the importance of spirituality in medicine and positively influences student perceptions of chaplains and their work.

Multisite validation of a 92-gene molecular classifier: Diagnostic accuracy and clinical utility in metastatic cancer.

10588 Background: Accurate tumor classification is increasingly critical to individualized care as patient outcomes improve with use of targeted cancer therapies and predictive biomarkers. In metastatic cancers of uncertain or unknown origin, identification of a primary site remains equivocal in a significant number of cases. Gene expression signatures may improve accuracy and specificity of tumor classification, however, large-scale, blinded validation studies that demonstrate stable performance in metastatic and poorly differentiated cases are currently lacking. Methods: Seven hundred and ninety cases (51% female, 44% metastatic, 63% grade 2 and 3, 14% limited tissue specimens) representing 28 tumor types and 50 subtypes were processed and adjudicated between Mayo Clinic, UCLA and Massachusetts General Hospital. Blinded FFPE tumor sections were submitted and tested using a 92-gene RT-PCR assay (CancerTYPE ID, bioTheranostics Inc.). Molecular predictions were evaluated for concordance with the reference diagnosis; diagnostic accuracy between clinical subsets was compared. Results: The 92-gene assay demonstrated overall sensitivities of 87% for tumor classification and 82% for subtyping. Forty-seven (5.9%) cases were considered unclassifiable. Comparative analysis of performance between metastatic (n=329) and primary (n=414) tumors showed no statistically significant difference in accuracy (85% vs 88%, p=0.16). Similarly, no significant decreases in performance were observed across histological grades (p=0.58) and when comparing limited tissue to excisional biopsy specimens (p=0.16). Strong precision was demonstrated for accurate identification of a primary tumor in tissues biopsied from common metastatic sites, reported as positive predictive values of 100% for lung, brain and peritoneum, 92% for ovary and 80% for liver. Conclusions: Results from this multisite, blinded study validate the diagnostic accuracy of the 92-gene assay for classifying a diverse set of tumors, and support its clinical utility in the diagnosis of metastatic tumors to determine tissue of origin, and in the differential diagnosis of metastatic vs new primary disease.

A Woman Post Mastectomy and Radiation Therapy With Chest Pain

HISTORY This was the third UCLA hospital admission for this 66-year-old female. Twenty-seven years ago the patient had breast cancer and underwent a left radical mastectomy without chemotherapy, and/or totalbody bone scanning. She then had recurrence in the left supraclavicular fossa involving the lymph nodes and the brachial plexus. She was treated with telecobalt beam over a single anterior dogleg-shaped portal. The field was shaped with modified lead bricks. A dose of 4000 rads (1 rad = 0.01 gy) was delivered over 5 weeks.

Analysis of Initial Slow Waves (ISWs) at the Seizure Onset in Patients with Drug Resistant Temporal Lobe Epilepsy

The goal of this study is to analyze initial slow waves (ISWs) at seizure onset in patients with refractory temporal lobe epilepsy. ISWs are a specific type of ictal EEG pattern characterized by a slow wave at the seizure onset followed by low voltage fast activity. Investigations were carried out on 14 patients from the UCLA hospital (USA) and 10 from the Ghent University Hospital (Belgium) implanted with depth and grid electrodes for localization of the epileptogenic zone. Sixty-one seizures in the UCLA group and 30 seizures in the Ghent group were analyzed. Fourteen UCLA and seven Ghent patients had ISWs at seizure onset. The duration of ISWs varied between 0.3 to 6.0 s and maximum amplitude varied from 0.2 to 1.4 mV. ISWs in three of 14 UCLA patients (30% of seizures) had a consistent positive polarity at the deepest contacts that were located in the amygdala, hippocampus, or entorhinal cortex and reversed polarity outside of these brain areas (ISWs1). ISWs in 11 of 14 UCLA patients (70% of seizures) had negative polarity at the deepest electrodes and their amplitude increased toward the recording contacts located in the white matter or neocortex (ISWs2). All ISWs from the seven Ghent patients were negative in the depth contacts (ISWs2) and positive on grid electrodes at the cortical surface. ISWs1 were associated with EEG spikes at the onset and on increase in amplitude of 10-20 Hz sinusoidal activity. In contrast, ISWs2 were associated with suppression of EEG amplitude, an increase in frequency in the range of 20-50 Hz, and did not have EEG spikes at the onset. Multiunit neuronal activity showed strong synchronization of neuronal discharges during interictal spikes, but multiunit synchronization was not obvious during ISWs2. The existence of EEG spikes and phase reversal with ISWs1 indicates this type of seizure may be triggered by hypersynchronous neuronal discharges; however, seizures with ISWs2 at the onset may be triggered by different mechanisms, perhaps nonneuronal.

John W. Kronik (1931–2006)

John W. Kronik died in the UCLA Hospital, in Los Angeles, California, on 22 January 2006. He had gone to Los Angeles on a ten-day winter vacation from his home in Ithaca, New York; he had been seri...

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Lndium-111 White Blood Cell Scans: Sensitivity, Specificity, Accuracy, and Normal Patterns of Distribution

The UCLA Hospital experience with indium-111 labeled white blood cells was reviewed. There were a total of 345 consecutive cases covering a broad range of clinical indications. The overall sensitivity of the method was 79%, specificity was 62%, and accuracy was 73%. The sensitivity for suspected osteomyelitis cases was 84%, with a specificity of 65% and an accuracy of 75%. For other cases sensitivity was 77%, specificity was 60%, and accuracy was 72%. Furthermore, patterns of normal distribution were reviewed.

Pertussis Immunization and Convulsions

A follow-up study of 18 infants and children who suffered convulsions (9 cases) or “hypotonic-hyporesponsive“ episodes (9 cases) within 48 hours following DTP immunization was conducted in the Depts of Pediatrics, UCLA Hospital and Clinics, and the Kaiser Permanente Medical Group, Los Angeles, CA.

The Authors’ Reply

Journal Article The Authors’ Reply Get access Myla Lai-Goldman, M.D., Myla Lai-Goldman, M.D. UCLA Hospital and Clinics Clinical Laboratories Center for the Health Sciences Los Angeles, California Search for other works by this author on: Oxford Academic Google Scholar Peter J. Howanitz, M.D., Peter J. Howanitz, M.D. UCLA Hospital and Clinics Clinical Laboratories Center for the Health Sciences Los Angeles, California Search for other works by this author on: Oxford Academic Google Scholar James H. MqBride, Ph.D. James H. MqBride, Ph.D. UCLA Hospital and Clinics Clinical Laboratories Center for the Health Sciences Los Angeles, California Search for other works by this author on: Oxford Academic Google Scholar American Journal of Clinical Pathology, Volume 88, Issue 4, 1 October 1987, Page 542, https://doi.org/10.1093/ajcp/88.4.542a Published: 01 October 1987

Gastrointestinal lymphomas

The classification of primary malignant lymphomas of the gastrointestinal tract by their cell of origin has been a subject of great controversy in recent years, with the proportion of histologic subtypes varying substantially in different published series. Much of this controversy was initially due to the widely recognized inherent difficulty of classifying lymphomas based on routine histologic sections alone. However, the advent of immunohistochemical techniques has also yielded disparate results. Particularly contentious has been the notion of true histiocytic lymphomas, which some investigators have claimed to be relatively frequent in the gastrointestinal tract, whereas others doubt whether they exist at all. We present here a classification of 25 gastrointestinal lymphomas seen in the surgical pathology services of UCLA Hospital and Stanford University Medical Center. Unlike all previously reported series, we have utilized frozen tissue sections for the performance of immunohistochemical studies, which we and others have found to be far more reliable than the use of formalin-fixed, paraffin-embedded tissues, particularly in detecting monoclonal surface staining of immunoglobulin light- and heavy-chain markers. We find that this technique lessens the likelihood of overinterpreting the stains for histiocyte markers (alpha 1-antitrypsin and lysozyme), which are often difficult to read owing to strong positive staining of benign reactive histiocytes within the tumor. Utilizing these techniques, we have been able to classify definitely 21 of our 25 lymphomas (84%) as of B-cell origin, whereas none appeared to be histiocytic. We conclude that true histiocytic lymphomas of the gastrointestinal tract must be very rare, and we recommend the routine use of frozen tissue sections for more accurate classification of these interesting lesions.

Determinants of failure in the treatment of ruptured abdominal aortic aneurysm.

One must identify those fatal errors in the treatment of patients with ruptured abdominal aortic aneurysms (AAAs) to improve future treatment and reduce mortality. Our vascular registry identified 29 patients with ruptured AAAs who died following admission to the UCLA Hospital, Los Angeles, and the Sepulveda (Calif) Veterans Administration Hospital between 1971 and 1981. Review of the records identified four categories of error that contributed to death. These included failure to proceed with elective aneurysmectomy in 12 patients with known AAAs, error in the diagnosis of aortic rupture that led to delay in getting nine patients to the operating room, intraoperative technical error that produced venous injury in eight patients, and undue delay in anesthetic induction in four patients. Following the outline of a careful treatment approach should further reduce the mortality in the treatment of patients with ruptured AAAs.

Rapidly progressive pneumonia in a young man

lerome R. Hoffman, MD: Today’s patient is a 35 year-old male who was in his usual state of good health until approximately six days prior to admission, when he suddenly developed chills, fever greater than 38.9”C (102”F), drenching sweats, nausea, vomiting, and yellow foul-smelling diarrhea while vacationing in St. Croix, Virgin Islands. The patient also noted a cough productive of yellow sputum, as well as mild headache and neck stiffness. The onset of symptoms occurred five hours after a shrimp dinner, and the patient also noted multiple bites and stings by fleas and mosquitoes while camping during his trip. He denied any rash. Two days after the onset of his symptoms the patient visited a local physician, who treated him with oral hydroxyzine and ampicillin, and told him that he had a “high white count.” When the patient’s symptoms worsened and he noted the onset of shortness of breath and a small amount of gross blood mixed in with his sputum, he flew home to Los Angeles and immediately presented to the Emergency Medicine Center at UCLA Hospital and Clinics.

Group G Streptococcal Arthritis

Five patients were seen in the UCLA hospital system with septic arthritis due to group G Streptococcus. All had prior joint disease or surgery on the affected joint. Findings from physical examination and laboratory evaluation were typical for pyogenic arthritis. Response to antimicrobial therapy was slow and marked by recurrent sterile joint effusions. Group G streptococcal arthritis may be diagnosed more frequently if routine serologic grouping of streptococcal isolates from joint fluid samples is performed. Such identification may also have prognostic significance.

Preventing nursing burnout: A challenge for liaison psychiatry

The authors conducted a study to assess and compare the level of job satisfaction among five groups of registered nurses working at UCLA Hospital. Fifty-seven female nurses completed the MMPI, Locus of Control Test, Work Environment Scale, and a questionnaire designed to assess job satisfaction. Results showed that there were no significant personality differences among the five groups of nurses. Significant differences between some of the groups were found in demographic variables and in work-related variables such as involvement, task orientation, work pressure, sense of authority on the job, and perceived communication with peers or other groups in the work environment. Nurses on the Medicine unit tended to have lower overall job satisfaction than those in the other units. The involvement of the Psychiatric Liaison Service on the five nursing units is described and discussed as a possible method for providing psychosocial support to the nurses and reducing high turnover rates.