Gonorrhea and Chlamydia Opt-Out Screening of Justice-Involved Women During Intake at the Los Angeles County Jail: The Pivotal Role of Correctional Health Systems.

Background: Chlamydia and gonorrhea are 2 of the most common sexually transmitted infections (STIs) worldwide, presenting major public health challenges and resulting in billions of dollars in direct medical costs in the United States. Incarcerated women have a particularly elevated risk of these infections, which can result in serious sequelae if left untreated. On December 13, 2021, the Los Angeles County Jail system began offering opt-out urogenital chlamydia and gonorrhea screening to all newly incarcerated women.

Hepatitis A Exposure Response and Outbreak Prevention in a Large Urban Jail - Los Angeles County, California, May-July 2023.

Correctional settings provide a high-risk environment for hepatitis A transmission because of the high proportion of homelessness and injection drug use among persons who are incarcerated. On May 30, 2023, Los Angeles County Department of Public Health informed the Communicable Disease Surveillance and Control (CDSC) unit of the Los Angeles County Jail system that a symptomatic incarcerated person had received a positive test result for acute hepatitis A. Upon learning the next day that the patient was a food handler, CDSC staff members identified 5,830 potential contacts of the index patient, 1,702 of whom had been released from the jail.

Characterizing predictors of COVID-19 vaccine refusal in an urban southern California jail population.

Background: Correctional populations have been disproportionately affected by COVID-19, and many large outbreaks have occurred in jails and prisons. Vaccination is a key strategy to reduce the SARS-CoV-2 transmission in carceral settings. Although implementation can be challenging due to vaccine hesitancy and medical mistrust, correctional settings provide largely equitable healthcare access and present a unique opportunity to identify potential predictors of vaccine hesitancy independent of access issues.

Not a Rare Disease Anymore? A Case of Ocular Syphilis at the Correctional Facility.

Los Angeles County has been facing a syphilis crisis since 2018. Cases of ocular syphilis have become increasingly identified and reported in the past few years, predominantly in HIV-positive men. Here we report a case of ocular syphilis in an otherwise healthy 49-year-old male in the Los Angeles County jail.

Risk factors for alcohol withdrawal-related hospital transfer in a correctional setting.

Introduction: A major health concern among individuals with alcohol use disorder is alcohol withdrawal syndrome (AWS), where individuals with physical dependence on alcohol may experience withdrawal signs and symptoms upon stopping or reducing alcohol use. AWS has a range of severity, with the most severe cases referred to as complicated AWS, presenting as seizure or signs and symptoms indicative of delirium or new onset of hallucinations. In the general community, risk factors or predictors of complicated AWS among hospitalized patients have been described, but there is no literature that examines such risk factors in a correctional population.

Characterizing and combating the opioid epidemic in the Los Angeles County jail system.

Introduction: Opioid overdose-related morbidity and mortality is a pressing public health crisis. Successful overdose reversal through bystander administration of naloxone is well documented, but there is an absence of literature on the implementation and impact of widespread naloxone access in a correctional setting during incarceration. The objective of this study was to describe our efforts to combat opioid overdose, prevent deaths, and examine and identify opioid use and predictors of opioid use through factors including age, sex assigned at birth, and ethnicity among the incarcerated population within the Los Angeles County jail system.

A Missing Piece of Diabetes Management: A Correctional Health Perspective.

A cross-sectional study was conducted in January 2020 to evaluate type 1 diabetes (T1D) management during and between incarcerations at the Los Angeles County Jail. Inclusion criteria were men with a T1D diagnosis who had been incarcerated twice within 5 years with at least two hemoglobin A1c values during each incarceration and a minimum of 3 months in the community between incarcerations. The primary outcome was the percentage change in A1c after release compared with the A1c during incarcerations.

Implementation of a COVID-19 Infection Control Plan in a Large Urban Jail System.

When the COVID-19 pandemic hit the United States, the number of people confined in correctional facilities on a single day numbered 1.8 million. Incarcerated people are at an increased risk of contracting and spreading SARS-CoV-2.

Robotic Vessel Sealer Device for Lymphocele Prevention After Pelvic Lymphadenectomy: Results of a Randomized Trial.

Pelvic lymph node dissection (PLND) during robotic prostatectomy is associated with potential complications. The most common complication of PLND is lymphoceles, occurring in up to 50% of patients in studies with screening imaging but usually asymptomatic. We performed a prospective randomized trial to evaluate whether using advanced bipolar energy for PLND via the robotic vessel sealer can prevent lymphoceles.

Establishing an Epidemiologic Profile of Hepatitis C Virus Infection at the Los Angeles County Jail.

Objective: The hepatitis C virus (HCV) is the most common blood-borne infection in the United States. Although 2% to 3% of the global population is estimated to be infected with HCV, an estimated 18% of the US prison population may be infected. The objective of this study was to establish an epidemiologic profile of HCV infection in the largest urban jail system in the United States.

Cook's Hernia: Renal Tumor Parasitic Vessels Herniating into Right Inguinal Canal.

We report the incidental findings and management of a hernia whose contents included renal tumor parasitic vessels in a 52-year-old male who presented with a 22 cm large right renal tumor. His initial complaints were right sided fullness and hematuria. Incidentally on CT scan, the patient's large right renal mass was identified, as well as lower pole parasitic tumor vessels which were herniating into the patient's right inguinal canal.

The Impact of Implementing an Advance Practice Pharmacist-Led Anticoagulation Clinic Within a Correctional Facility.

Maintaining warfarin in the therapeutic range is clinically challenging and can be made more complex in the correctional health setting. The care of an inmate population is complicated by its episodic and often brief nature in addition to the frequent lack of consistent care prior to incarceration. As part of a process improvement effort, a descriptive study was conducted on a unique pharmacist-led anticoagulation clinic that was initiated in the Los Angeles County jail.

Impact of a Pharmacist-Led Diabetes Clinic in a Correctional Setting.

Incarcerated patients often have a high disease burden and poor access to care in the community. In an effort to ensure glycemic control and appropriate initiation of statin therapy for cardiovascular (CV) risk reduction, a pilot program of pharmacist-led diabetes clinic (PLDC) was implemented in a large inner-city jail. A pre-post study was conducted as a quality improvement initiative.

Clinical Pharmacist's Role in an Alcohol Detox Unit in a Correctional Setting.

Introduction: Newly incarcerated inmates with chronic alcohol use are at high risk for alcohol withdrawal. This descriptive study aims to describe the role of a clinical pharmacist within an alcohol detoxification unit (ADU) in the Los Angeles County jail that serves nearly 18 000 inmates facility-wide daily.

Methods: This descriptive analysis was conducted from August 2, 2018 through October 31, 2018 within the jail ADU.

Case-controlled Analysis of Patient-based Risk Factors for Assault in the Healthcare Workplace.

Introduction: Violence against healthcare workers in the medical setting is common and associated with both physical and psychological adversity. The objective of this study was to identify features associated with assailants to allow early identification of patients at risk for committing an assault in the healthcare setting.

Methods: We used the hospital database for reporting assaults to identify cases from July 2011 through June 2013.

Reduction in Jail Emergency Department Visits and Closure After Implementation of On-Site Urgent Care.

This descriptive study evaluates the impact of implementation of full service on-site urgent care services at the Los Angeles County Jail (LACJ) by examining the number of patients seen at the referral hospital, Los Angeles County + University of Southern California Medical Center (LAC+USC), and the number of hours that the referral hospital was closed to transfers in the periods before and after the development of the LACJ Urgent Care. The appropriate utilization of public resources is a critical priority for an overburdened county medical health care system. Implementing on-site urgent care staffed by emergency physicians led to reductions in the average number of patients transferred to LAC+USC, the average number of monthly closure hours, and the average days per month when closure to transfer occurred, and a cost savings of some $2 million, primarily in personnel costs.

Inadequate Sensitivity of Laboratory Risk Indicator to Rule Out Necrotizing Fasciitis in the Emergency Department.

Introduction: Necrotizing fasciitis (NF) is a life-threatening illness, particularly when surgical debridement is delayed. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed to identify patients at higher risk for NF. Despite limited information in this regard, the LRINEC score is often used to "rule out" NF if negative.

Aminocaproic Acid and Tranexamic Acid Fail to Reverse Dabigatran-Induced Coagulopathy.

In recent years, dabigatran has emerged as a popular alternative to warfarin for treatment of atrial fibrillation. If rapid reversal is required, however, no reversal agent has clearly been established. The primary purpose of this manuscript was to evaluate the efficacy of tranexamic acid and aminocaproic acid as agents to reverse dabigatran-induced coagulopathy.

Primary Ureteral Lymphoma Presenting with Acute Flank Pain.

Non-Hodgkin's lymphoma (NHL) represents 4% of newly diagnosed cancer in 2013 with a 59-82% 5-year survival depending on the tumor location. Primary presentation of lymphoma consists of lymphadenopathy or swelling of the lymph nodes and non-specific systemic symptoms such as fevers, night sweats, and weight loss. Less commonly, NHL arises from non-lymphoid tissue.

False-Positive Cystoscopic Diagnosis of Ureteral Obstruction After Hysterectomy Due to a Nonfunctional Kidney.

Background: An estimated 0.2% of the population may have a unilateral nonfunctional kidney. This pre-existing condition may lead to the mistaken presumption that a ureteral injury has occurred when performing cystoscopy after hysterectomy.

Anticoagulation drug therapy: a review.

Historically, most patients who required parenteral anticoagulation received heparin, whereas those patients requiring oral anticoagulation received warfarin. Due to the narrow therapeutic index and need for frequent laboratory monitoring associated with warfarin, there has been a desire to develop newer, more effective anticoagulants. Consequently, in recent years many novel anticoagulants have been developed.

Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission.

Study Objective: Older adults are frequently hospitalized from the emergency department (ED) after an episode of unexplained syncope. Current admission patterns are costly, with little evidence of benefit. We hypothesize that an ED observation syncope protocol will reduce resource use without adversely affecting patient-oriented outcomes.

Death notification in the emergency department: survivors and physicians.

When patients die in the emergency department (ED), emergency physicians (EP) must disclose the bad news to family members. The death is often unexpected and the act of notification can be difficult. Many EPs have not been trained in the skill of communicating death to family members.