New York Hospital Research Articles

Abstract 17578: Improving Access to Care With a Structural Heart Disease Program in a Metropolitan Public Healthcare System

Background: Public hospitals face challenges in providing access to structural heart interventions due to limited resources. Our aim is to describe the implementation and outcomes of a comprehensive, multi-disciplinary Structural Heart Disease Program (SHDP) in the largest public healthcare system in the United States, as a strategy to mitigate healthcare disparities and improve access to care. Methods: The SHDP at Bellevue Hospital serves as the referral center for 11 public hospitals in New York. It launched in 2022 and added a hybrid OR in March 2023. We collected clinical, demographic, and socioeconomic data for patients undergoing structural heart interventions. Results: A total of 56 patients were included from January 2022 to June 2023. The median age was 60 years (22-93 years), 59% were women, 41% were Black, 38% Hispanic, 11% White and 9% Asian. Most patients were immigrants (71%), 28.5% were uninsured, 37.5% were undocumented and 41% required an English interpreter. Only 21% of patients completed high school and 9% completed college. The most common procedure was PFO closure (30%) followed by M-TEER and BAV (Figure 1). For TAVRs and M-TEERs combined, the 30-day re-admission rate was 7.1% (n=1) and 30-day mortality was 0%, with no differences by ethnic group. Length of stay varied by procedure and there were low rates of procedural complications (Table 1). Conclusions: Our multidisciplinary SHDP program demonstrates feasibility to provide care to underserved populations in a public healthcare system with excellent outcomes. Further study of strategies aimed at improving access to structural heart interventions is warranted.

Value of Repeat Renal Biopsies in Lupus Nephritis in Two Large Inner-City Hospitals in New York

Value of Repeat Renal Biopsies in Lupus Nephritis in Two Large Inner-City Hospitals in New York

Financial hardship experienced in adults with metastatic breast cancer (MBC) from diverse racial, ethnic, and socio-economic backgrounds.

276 Background: MBC profoundly impacts physical, psychosocial, and financial well-being. With treatment advances, patients often manage ongoing treatment for extended durations, which has employment and financial implications (e.g., missed work for appointments). As part of a study evaluating the “collateral damage” of MBC, we sought to describe employment and financial challenges, with a focus on Black and Hispanic adults living with MBC. Methods: From 5/22-5/23, English or Spanish speaking adults with MBC (de novo stage IV or recurrent) treated at 4 New York Presbyterian (NYP) sites (Weill Cornell Medicine-Manhattan, NYP-Brooklyn Methodist, NYP-Queens, and NYP-Columbia) were invited to complete a survey that included a measure of collateral damage (SHINE-financial and employment concerns) and social determinants of health. Fisher’s Exact tests were used to assess differences by race and ethnicity. Results: Of 87 respondents, 14% identified as Hispanic, 28% non-Hispanic Black (NHB), 41% non-Hispanic White (NHW), 7% Asian American Pacific Islander (AAPI), and 10% other/multiracial; 41% did not have a college degree, 32% were employed, 19% unemployed, 9% homemakers, 27% retired, and 13% disabled. Employment concerns were prevalent across racial and ethnic groups; Black, Hispanic, and AAPI participants were more likely to report financial concerns (Table). While 100% of Hispanic, NHW, and AAPI participants reported having stable housing, 29% of NHB participants were worried about losing housing (p=.002). 42% of Hispanic and 45% of NHB participants (vs. 8%, NHW and 0%, AAPI, p=.007) were food insecure; 18% of Hispanic and 17% of NHB adults indicated lack of reliable transportation in the last year (vs. 0%, NHW/AAPI, p=.041). Conclusions: NHB and Hispanic MBC patients report higher levels of financial concern and are more likely to experience food and transportation insecurity, compared to NHW patients. Evaluating the role of screening to systematically connect patients with resources to address unmet social and financial needs should be prioritized in an effort to identify feasible approaches to support economically vulnerable patients following an MBC diagnosis.[Table: see text]

Alarm burden and the nursing care environment: a 213-hospital cross-sectional study

BackgroundHigh rates of medical device alarms in hospitals are a well-documented threat to patient safety. Little is known about organisational features that may be associated with nurses’ experience of alarm...

The association of the emergency department work environment on patient care and nurse job outcomes.

To determine the association between emergency nurses' work environments and patient care quality and safety, and nurse burnout, intent to leave, and job dissatisfaction. Cross-sectional study of 221 hospitals in New York and Illinois informed by surveys from 746 emergency nurses and 6932 inpatient nurses with linked data on hospital characteristics from American Hospital Association Annual Hospital Survey. The RN4CAST-NY/IL study surveyed all registered nurses in New York and Illinois between April and June 2021 about patient safety, care quality, burnout, intent to leave, and job dissatisfaction and aggregated their responses to specific hospitals where they practiced. Work environment quality was measured using the abbreviated Practice Environment Scale of the Nursing Work Index. Generalized estimating equations were used to determine the relationship between emergency nurses' work environments on patient care and nurse job outcomes. A total of 58% of emergency nurses reported high burnout, 39% reported job dissatisfaction, and 27% indicated intent to leave their job in the next year. Nurses in hospitals with good (vs mixed) or mixed (vs poor) emergency work environments were less likely to report unfavorable patient care quality and hospital safety grades, and were less likely to experience high burnout, job dissatisfaction, and intentions to leave the job, by factors ranging from odds ratio (OR) 0.21 (95% confidence interval [CI], 0.16-0.29) to OR 0.46 (95% CI, 0.34-0.61). Given the complex and high stakes nature of emergency nursing care, leaders should place a high priority on organizational solutions targeting improved nurse staffing and work environments to advance better patient and clinician outcomes.

Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults

Despite the benefits of goals-of-care (GOC) communication, many hospitalized individuals never communicate their goals or preferences to clinicians. To assess whether a GOC video intervention delivered by palliative care educators (PCEs) increased the rate of GOC documentation. This pragmatic, stepped-wedge cluster randomized clinical trial included patients aged 65 years or older admitted to 1 of 14 units at 2 urban hospitals in New York and Boston from July 1, 2021, to October 31, 2022. The intervention involved PCEs (social workers and nurses trained in GOC communication) facilitating GOC conversations with patients and/or their decision-makers using a library of brief, certified video decision aids available in 29 languages. Patients in the control period received usual care. The primary outcome was GOC documentation, which included any documentation of a goals conversation, limitation of life-sustaining treatment, palliative care, hospice, or time-limited trials and was obtained by natural language processing. A total of 10 802 patients (mean [SD] age, 78 [8] years; 51.6% male) were admitted to 1 of 14 hospital units. Goals-of-care documentation during the intervention phase occurred among 3744 of 6023 patients (62.2%) compared with 2396 of 4779 patients (50.1%) in the usual care phase (P < .001). Proportions of documented GOC discussions for Black or African American individuals (865 of 1376 [62.9%] vs 596 of 1125 [53.0%]), Hispanic or Latino individuals (311 of 548 [56.8%] vs 218 of 451 [48.3%]), non-English speakers (586 of 1059 [55.3%] vs 405 of 863 [46.9%]), and people living with Alzheimer disease and related dementias (520 of 681 [76.4%] vs 355 of 570 [62.3%]) were greater during the intervention phase compared with the usual care phase. In this stepped-wedge cluster randomized clinical trial of older adults, a GOC video intervention delivered by PCEs resulted in higher rates of GOC documentation compared with usual care, including among Black or African American individuals, Hispanic or Latino individuals, non-English speakers, and people living with Alzheimer disease and related dementias. The findings suggest that this form of patient-centered care delivery may be a beneficial decision support tool. ClinicalTrials.gov Identifier: NCT04857060.

Abstract P226: Length Of Stay Discrepancies Between Rural And Urban Hospital Settings For Hypertension Admissions

Introduction: Rural populations experience greater barriers to healthcare access compared to urban populations. This can be attributed to fewer public health services, greater uninsured rate, and greater burden of healthcare shortages in urban healthcare settings. Our study aims to quantify the disproportionate allocation in healthcare resources through analysis of Length of Stay (LOS) in-respect to hypertensive urgency and hypertensive urgency. Methods: This cross-sectional study reviewed the LOS estimates for patients with ICD-10 diagnoses for Hypertension Emergency or Hypertension Urgency within the state of New York, categorized by the type of community hospital; rural or urban. This study utilizes the 2020 National Inpatient Sample (NIS), specifically for urban and rural hospitals in New York. ICD-10 codes included I16.1 &amp; I16.9 for Hypertensive Emergency and I16.0 for Hypertensive Urgency. Community hospital setting was categorized as either rural or urban based on the overlying zip code of the admitting inpatient hospital. Results: LOS was unique to the community setting (p&lt;0.01), but not to hypertensive disease (p=0.11). In summary, the LOS was longer in rural-level inpatient hospital systems when compared to their urban counterparts in both Hypertensive Urgency, 4.4 days vs 3.1 days (p=0.01), and Hypertensive Emergency, 5.5 days vs 3.4 days (p&lt;0.01). Conclusion: The LOS of patients admitted for both hypertensive urgency and emergency were significantly higher in rural hospitals. Furthermore, increased disease severity emphasizes the divide in LOS between the community healthcare settings. Redistribution of resources to rural communities can enhance access to preventative healthcare services, specialty healthcare, and potentially decrease overall community disease burden.

Ciprofloxacin-resistant ST198 Salmonella Kentucky in a hospitalized American black bear (Ursus americanus), with evidence of subsequent nosocomial transmission.

Global emergence of ciprofloxacin-resistant ST198 Salmonella Kentucky poses an important public health threat. While conducting Salmonella surveillance among wildlife patients admitted to our veterinary medical teaching hospital in central New York, we isolated multidrug-resistant (MDR) ST198 Salmonella Kentucky from an American black bear (Ursus americanus) in September 2020. The isolate was phenotypically resistant to numerous antimicrobial agents, including ceftriaxone and ciprofloxacin, and several antimicrobial resistance genes and mutational resistance determinants were detected. Between April and July 2021, the same strain of MDR ST198 Salmonella Kentucky was also isolated from seven other wildlife patients and multiple hospital environmental locations, suggesting nosocomial transmission. Ciprofloxacin resistance is conferred by triple point mutations in the quinolone resistance-determining regions (QRDRs), a genotypic profile indicative of Clade ST198.2. To our knowledge, this is the first report of this ciprofloxacin-resistant clade being identified in animals or animal products in the United States. Timely resolution of the outbreak was achieved following efforts to further enhance environmental disinfection protocols and biosecurity measures at the hospital, with no known cases or positive environmental samples after July 2021.

Evaluation of a Zoonotic Orthopoxvirus PCR Assay for the Detection of Mpox Virus Infection

An epidemic caused by an outbreak of monkeypox (mpox) in May 2022 rapidly spread internationally, requiring an urgent response from the clinical diagnostics community. A detailed description of the clinical validation and implementation of a laboratory-developed real-time PCR test for detecting nonvariola Orthopoxvirus-specific DNA based on the newly designed RealStar Zoonotic Orthopoxvirus assay is presented. The validation was performed using an accuracy panel (n=97) comprising skin lesion swabs in universal transport media and from mpox virus genomic DNA spiked into pooled mpox virus-negative remnant universal transport media of lesion specimens submitted for routine clinical testing in the NewYork-Presbyterian Hospital clinical laboratory system. Accuracy testing demonstrated excellent assay agreement between expected and observed values and comparable diagnostic performance to three different reference tests. Analytical sensitivity with 95% detection probability was 126 copies/mL, and analytical specificity, clinical sensitivity, and clinical specificity were 100%. In summary, the RealStar Zoonotic Orthopoxvirus assay provides a sensitive and reliable method for routine diagnosis of mpox infections.

Applying User-Centered Design and Implementation Science to the Early-Stage Development of a Telehealth-Enhanced Hybrid Cardiac Rehabilitation Program: Quality Improvement Study.

Cardiac rehabilitation (CR) is an evidence-based intervention that improves event-free survival in patients with cardiac conditions, yet <27% of all eligible patients use CR in the United States. CR is traditionally delivered in clinic-based settings where implementation barriers abound. Innovative nontraditional program designs and strategies are needed to support widespread CR uptake. This study aimed to demonstrate how user-centered design (UCD) and implementation science (IS) principles and methods can be integrated into the early-stage development of nontraditional CR interventions. As part of a NewYork-Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we combined UCD and IS principles and methods to design a novel home- and clinic-based telehealth-enhanced hybrid CR (THCR) program. We co-designed this program with multilevel stakeholders using an iterative 3-step UCD process to identify user and contextual barriers and facilitators to CR uptake (using semistructured interviews and contextual inquiry [step 1]), design an intervention prototype that targets contextual and user factors and emulates the evidence-based practice (through design workshops and journey mapping [step 2]), and review and refine the prototype (according to real-world usability testing and feedback [step 3]). The UCD process was informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research. At step 1, we conducted semistructured interviews with 9 provider- and system-level stakeholders (female: n=6, 67%) at 3 geographically diverse academic medical centers, which revealed behavioral (eg, self-efficacy and knowledge) and contextual (eg, social distancing guidelines, physical space, staffing, and reimbursement) barriers to uptake; hybrid delivery was a key facilitator. Step 2 involved conducting 20 design workshops and 3 journey-mapping sessions with multidisciplinary NYPH stakeholders (eg, digital health team, CR clinicians, and creative director) where we identified key design elements (eg, mix of clinic- and home-based CR and synchronous remote patient monitoring), yielding an initial THCR prototype that leveraged NYPH's telehealth infrastructure. At step 3, we conducted usability testing with 2 CR clinicians (both female) administering home-based sessions to 3 CR patients (female: n=1, 33%), which revealed usability themes (eg, ease of using remote patient monitoring devices or a telehealth platform, technology disruptions, and confidence in using the telehealth platform to safely monitor patients) and design solutions (eg, onboarding sessions, safety surveys, and fully supervised remote sessions) to be included in the final THCR prototype. Combining UCD and IS methods while engaging multidisciplinary stakeholders in an iterative process yielded a theory-informed THCR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process and guidance for incorporating UCD and IS principles and methods into the early-stage development of a nontraditional CR intervention. The feasibility, acceptability, appropriateness, and usability of the final THCR prototype is being evaluated in an ongoing study.

The Impact of Cocaine Use and the Obesity Paradox in Patients With Heart Failure With Reduced Ejection Fraction Due to Non-ischemic Cardiomyopathy.

Background Obesity and illicit drugs are independent risk factors for developing heart failure (HF). However, recent studies have suggested that patients who already have HF and are obese have better clinical outcomes. We aim to study the effect of cocaine use on this obesity paradox phenomenon as it pertains to HF readmissions. Methodology In a retrospective chart analysis, we reviewed patients with a diagnosis of HF with reduced ejection fraction (HFrEF) admitted to Metropolitan Hospital in New York. We studied the association between body mass index (BMI) categories, namely, non-obese (<30 kg/m2) and obese (≥30 kg/m2), cocaine use, and the primary outcome (time to readmission for HF within 30 days after discharge). The interaction between cocaine and obesity status and its association with the primary outcome was also assessed. Results A total of 261 patients were identified. Non-obese status and cocaine use were associated with an increased hazard of readmission in 30 days (hazard ratio (HR) = 2.28, p = 0.049 and HR = 3.12, p = 0.004, respectively). Furthermore, cocaine users who were non-obese were over six times more likely to be re-admitted in 30 days compared to non-cocaine users who were obese (HR = 6.45, p = 0.0002). Conclusions Non-obese status and continued use of cocaine have a negative additive effect in impacting HF readmissions.

Psychosocial well-being during the COVID-19 pandemic among women with and without breast cancer.

Treatment delays in combination with general social distancing practices to reduce transmission may have negative impacts on the mental health of women with breast cancer who may need more social and emotional support. We sought to elucidate the psychosocial effects of the COVID-19 pandemic among women with and without breast cancer in New York City. We conducted a prospective cohort study among women aged 18+ across the spectrum of breast health care at New York Presbyterian (NYP)-Weill Cornell, NYP-Brooklyn Methodist Hospital and NYP-Queens. Women were contacted between June and October 2021 to assess their self-reported depression, stress, and anxiety during the COVID-19 pandemic. We compared women who were recently diagnosed, those with a history of breast cancer, and women without cancer whose other health visits were delayed during the pandemic. There were 85 women who completed the survey. Breast cancer survivors (42%) were the least likely to report a delay in care due to COVID compared to breast cancer patients who were recently diagnosed (67%) and women without cancer (67%). Compared to women without cancer and breast cancer survivors, women recently diagnosed with breast cancer reported higher levels of anxiety and depression with a statistically significant difference in perceived stress. Our findings highlight the need to identify and risk-stratify patients facing a new breast cancer diagnosis in and around the COVID-19 pandemic who may benefit from additional resources to mitigate the adverse impacts of the pandemic and a breast cancer diagnosis on psychosocial health.

Sex Differences in Clinical Presentation and Management in Eosinophilic Esophagitis

Background: Eosinophilic esophagitis (EoE) is a male predominant disease, typically presenting with dysphagia. Our goal was to investigate sex differences in clinical presentation and management of EoE. Methods: We performed a retrospective cross-sectional review of 489 EoE patients seen at NewYork Presbyterian Weill Cornell from August 2015 to August 2019. Charts were queried for age at diagnosis, symptoms at presentation, endoscopic findings, need for dilations, and medical therapy. Student t and χ2 tests were implemented to compare outcome variables of the 2 independent groups (males vs females) and logistic regressions for invariable and multivariable analyses. Results: 489 EoE patients (226 Female [F] [46.2%], 263 Male [M] [53.8%]) were reviewed. Males were more likely to present with food impaction (92 [35.8%] vs 44 [19.7%], M vs F, P &lt; .001), have a fibrostenotic phenotype on initial endoscopy (140 [54.1%] vs 98 [45.0%], M vs F, P = .043) and undergo dilation (odds ratio [OR] = 1.985, 95% confidence interval [CI] = 1.209-3.328, P &lt; .01). Female patients were more likely to have atopic disease (153 [67.6%] vs 153 [58.8%], F vs M, P = .044) and a reported normal index endoscopy (79 [36.2%] vs 69 [26.6%], F vs M, P = .026). Conclusion: This large retrospective review highlights clinically important differences in presentation between sexes. Increasing awareness of these differences, especially history of atopic disease, impaction, and the need for dilation, can help clinicians better identify EoE in female patients and therefore, guide initial therapy. The mechanistic underpinnings of these discrepancies are not evident from this data and will require future studies.

Improving Hospital Preparedness for Pediatric Abductions

Introduction:In the United States, 840,000 children are reported missing annually. While no concise data is available on the incidence from healthcare facilities, infant and child abductions and elopement events pose a high risk to infants and hospital staff. Following an update on the missing child and missing infant policy at a tertiary care hospital in New York, the hospital’s emergency preparedness team conducted a full-scale hospital drill. The drill included input and participation from administration, nursing, hospital police, and the pediatric department.Method:New updates in the policy which had not been tested before were evaluated during this drill, including plain language verbiage to activate a code, the process of alerting hospital police of the missing pediatric patient, hospital police response, and the response of hospital staff in their work areas. Inpatient pediatric wards, the emergency department, and outpatient clinics were given teaching about the new policy and their responsibilities in the event of a missing child or infant. Evaluators were pre-selected and placed throughout the hospital. Afterward, controllers de-briefed with each of the evaluators as well as with hospital personnel in areas that did not receive teaching on the policy.Results:The areas that did not receive in-person training on the policy update wanted to assist but did not know how to respond and did not follow protocol for securing their areas. Furthermore, areas of the hospital were identified where the overhead paging system did not work as well as gaps in hospital police staffing to cover key hospital exit points.Conclusion:This drill revealed that all hospital personnel need dedicated and personalized training on policy updates highlighting their roles in response, communication lines need to be tested, and plans to address concurrent clinical emergencies need to be formulated.

Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records.

A growing body of literature has linked usability limitations within electronic health records (EHRs) to adverse outcomes which may in turn affect EHR system transitions. NewYork-Presbyterian Hospital, Columbia University College of Physicians and Surgeons (CU), and Weill Cornell Medical College (WC) are a tripartite organization with large academic medical centers that initiated a phased transition of their EHRs to one system, EpicCare. This article characterizes usability perceptions stratified by provider roles by surveying WC ambulatory clinical staff already utilizing EpicCare and CU ambulatory clinical staff utilizing iterations of Allscripts before the implementation of EpicCare campus-wide. A customized 19-question electronic survey utilizing usability constructs based on the Health Information Technology Usability Evaluation Scale was anonymously administered prior to EHR transition. Responses were recorded with self-reported demographics. A total of 1,666 CU and 1,065 WC staff with ambulatory self-identified work setting were chosen. Select demographic statistics between campus staff were generally similar with small differences in patterns of clinical and EHR experience. Results demonstrated significant differences in EHR usability perceptions among ambulatory staff based on role and EHR system. WC staff utilizing EpicCare accounted for more favorable usability metrics than CU across all constructs. Ordering providers (OPs) denoted less usability than non-OPs. The Perceived Usefulness and User Control constructs accounted for the largest differences in usability perceptions. The Cognitive Support and Situational Awareness construct was similarly low for both campuses. Prior EHR experience demonstrated limited associations. Usability perceptions can be affected by role and EHR system. OPs consistently denoted less usability overall and were more affected by EHR system than non-OPs. While there was greater perceived usability for EpicCare to perform tasks related to care coordination, documentation, and error prevention, there were persistent shortcomings regarding tab navigation and cognitive burden reduction, which have implications on provider efficiency and wellness.

The First Dedicated Comprehensive Heart Failure Program in the United States: The Division of Circulatory Physiology at Columbia Presbyterian (1992–2004)

The first dedicated multidisciplinary heart failure program in the United States was founded as the Division of Circulatory Physiology at the Columbia University College of Physicians & Surgeons in 1992. The Division was administratively and financially independent of the Division of Cardiology and grew to 24 faculty members at its peak. Its administrative innovations included (1) a comprehensive full-integrated service line, with 2 differentiated clinical teams, one devoted to drug therapy and the other to heart transplantation and ventricular assist devices; (2) a nurse specialist/physician assistant–led clinical service; and (3) a financial structure independent of (and not supported by) other cardiovascular medical or surgical services. The division had 3 overarching missions: (1) to promote a unique career development path for each faculty member to be linked to recognition in a specific area of heart failure expertise; (2) to change the trajectory and enhance the richness of intellectual discourse in the discipline of heart failure, so as to foster an understanding of fundamental mechanisms and to develop new therapeutics; and (3) to provide optimal medical care to patients and to promote the ability of other physicians to provide optimal care. The major research achievements of the division included (1) the development of beta-blockers for heart failure, from initial hemodynamic assessments to proof-of-concept studies to large-scale international trials; (2) the development and definitive assessment of flosequinan, amlodipine, and endothelin antagonists; (3) initial clinical trials and concerns with nesiritide; (4) large-scale trials evaluating dosing of angiotensin converting-enzyme inhibitors and the efficacy and safety of neprilysin inhibition; (5) identification of key mechanisms in heart failure, including neurohormonal activation, microcirculatory endothelial dysfunction, deficiencies in peripheral vasodilator pathways, noncardiac factors in driving dyspnea, and the first identification of subphenotypes of heart failure and a preserved ejection fraction; (6) the development of a volumetric approach to the assessment of myocardial shortening; (7) conceptualization and early studies of cardiac contractility modulation as a treatment for heart failure; (8) novel approaches to the identification of cardiac allograft rejection and new therapeutics to prevent allograft vasculopathy; and (9) demonstration of the effect of left ventricular assist devices to induce reverse remodeling, and the first randomized trial showing a survival benefit with ventricular assist devices. Above all, the division served as an exceptional incubator for a generation of leaders in the field of heart failure.

Abstract P571: Investigating Factors Relevant to Understanding the Hispanic Health Paradox in Patients After Cardiac Arrest

Introduction: The growing Hispanic community faces disproportionate hardship due to lower financial capital and educational opportunity. The Hispanic health paradox refers to the finding that Hispanics tend to have better cardiovascular outcomes than non-Hispanics, despite facing greater hardships and more cardiovascular risk factors. Behavioral (e.g., sleep) and psychological (e.g., optimism) factors predict recovery after acute coronary syndrome events, but less is known about how these factors differ by ethnicity after cardiac arrest (CA). We tested demographic, psychological, behavioral, and recovery factors that may underlie the Hispanic health paradox among CA survivors. Hypothesis: We hypothesized that Hispanic vs. non-Hispanic cardiac arrest survivors would have lower income and education but would not differ in behavioral, psychological, and recovery factors. Methods: An observational cohort study, Psychological predictors of recovery after an Acute Cardiac Event (PACE) , enrolled 68 neurologically intact CA survivors admitted to NewYork-Presbyterian Hospital. At hospital discharge, self-reported demographic, psychological, behavioral, and recovery variables were assessed. Independent-samples t-tests of Hispanic vs. non-Hispanic CA survivors were conducted comparing income, education, posttraumatic stress symptoms, depression, negative affect, cardiac anxiety, optimism, positive affect, social support, sleep, physical activity, independent activities of daily living, and self-maintenance. Results: As hypothesized, Hispanic vs. non-Hispanic participants had lower income, Mann Whitney U = 99.00, z = -3.46, p &lt; .01, and lower education, Mann Whitney U = 336.00, z = -2.65, p = .01. Unexpectedly, Hispanic patients reported greater cardiac anxiety M = 39.60, SD = 16.70) than non-Hispanic patients ( M = 30.29, SD = 11.67), t (66) = -2.722, p = .008. No other tested factors were significant, all p s ≥ .419. Conclusions: Cardiac anxiety is the only tested variable that differed by ethnicity. While Hispanic ethnicity may be protective for certain aspects of cardiovascular health, the present findings indicate that Hispanic CA survivors experience higher psychological distress, which itself is a known risk factor for poor health behaviors. Future research should assess potential drivers of cardiac anxiety (e.g., mistrust of healthcare system, poor patient-physician communication). Future intervention research should target heart-related fear during CA recovery.

Benjamin Daniel Shogan, MD, FACS, FASCRS.

Ben Shogan, MD, is a staff Colon and Rectal Surgeon and Associate Professor of Surgery at University of Chicago in Chicago, IL. Ben's mother was born and raised in a small town in Germany before moving to the U.S. in her mid-20s, while his father was born and raised on Long Island, NY. Ben was born in Long Island Jewish Hospital in New York and grew up in New Jersey. He attended the University of Rochester in Rochester, NY, where he received a Bachelor of Science in Microbiology. From there he attended medical school at Rutgers New Jersey Medical School in Newark, NJ. He then performed his General Surgery residency at the University of Chicago prior to completing his Colorectal Surgery fellowship at the Mayo Clinic in Rochester, MN.

Non-neonatal Men with Rare Testicular Torsion: A Case Series

Abstract Testicular torsion involves the testicle twisting which results in an infarcted testis. Emergency surgery is required to salvage the affected testis. There are 2 anatomic pathologies associated with testicular torsion: intravaginal testicular torsion and extravaginal testicular torsion (ETT). Extravaginal testicular torsion is seen perinatally and in neonates; beyond this period, ETT is regarded as exceptionally rare. This case series presents 7 cases of ETT seen in men aged 14 to 20 years. This is the largest and oldest group of patients seen with this pathology. These cases were defined by a pediatric surgeon in an inner city hospital in New York. Two patients' testes were not viable at the time of presentation, and the time of onset to presentation ranged from 30 minutes to 11 hours. Each of these cases had an orchiopexy concomitantly of the contralateral testis. This case series poses key questions regarding the etiology of ETT and the surgical management of such cases.

Ralph L. Sacco, 65, Dies

![Graphic][1]</img> Ralph L. Sacco, MD, MS, FAAN, FAHA, the only physician to have served as both the president of the American Heart Association (AHA) and the American Academy of Neurology (AAN), the first neurologist to serve as president of the AHA, and an expert on stroke risk and prevention, died January 17, 2023, of a brain tumor at his home in Long Island, NY. The founder of the Northern Manhattan Study, a professor of neurology, public health sciences, human genetics, and neurosurgery at the University of Miami's Miller School of Medicine and the Olemberg Family Chair in Neurological Disorders, he was 65. For Dr. Sacco, who grew up in Margate City, NJ, 3 blocks from the Jersey shore, there was no more peaceful place than the beach. After settling in New York to do his residency in neurology in 1983 at Columbia Presbyterian Hospital, he began to spend his free time in the Hamptons where he developed a zeal for boating, interior design, and architecture. The eldest of 5 children, Dr. Sacco occasionally worked in the family business, Sack O′ Subs, cutting cold cuts and stacking steaks. “I didn't like working around food because I ate too much,” he would later confess, adding that he preferred his paper route, except when being chased by dogs. He set his sights on medicine after an aunt suggested that he would be well-suited for the career. Growing up in the disco era, he and his sister, Bess, 2 years his junior, would frequent the dance clubs in Atlantic City and Wildwood, NJ, along with mutual friends. Few people knew that he was skilled at freestyle—save those who later invited him to their weddings, and the close friends that he called his chosen family who accompanied him and his husband, Scott Dutcher, on coastal vacations … [1]: /embed/inline-graphic-1.gif