New York Hospital Research Articles

Detection of Enteroviruses in a Pediatric Oncology Patient Population

Abstract Enteroviruses are responsible for around 10 to 15 million infections and tens of thousands of hospitalizations annually. Infants, children, and people with weakened immune systems are more likely to get hospitalized and can have serious complications from enterovirus infection. Non-polio enteroviruses like EV-D68 can cause mild to severe symptoms like wheezing, difficulty breathing and acute flaccid myelitis (AFM). Therefore, it is crucial to continue to monitor the prevalence of enteroviruses, especially those that can potentially cause severe symptoms like EV-D68. This study focused on determining the prevalence of enteroviruses in a pediatric oncology patient population. Residual Nasopharyngeal swabs (NPS) specimens, collected from pediatric patients (<18 years old) presenting to a cancer hospital in New York between September 2022 and December 2022, and September 2023 and December 2023 for cancer care were included in the study. Rhinovirus/Enterovirus (RV/EV) was detected using the BioFire FilmArray Respiratory Panel (bioMerieux, Inc.) or the ePlex Respiratory Pathogen Panel (GenMark/Roche Molecular). For Enterovirus identification, RNA was extracted from the RV/EV positive NPS using the KingFisher™ Flex Magnetic Particle Processors (Thermo Scientific, USA), followed by RT-PCR in the ABI 7500 Fast real-time PCR instrument (ThermoFisher, USA) for enteroviruses and EV-D68 using pan-Enterovirus and EV-D68 specific primers, respectively. A total of 880 and 694 NPS samples from patients <18 years old were tested during the study period in 2022 and 2023, respectively. Of these, 238 (238/880; 27%) and 225 (225/694; 32%) RV/EV positives NPS were detected in 2022 and 2023 respectively. A total of 370 (370/463; 80%) RV/EV positive samples (182 samples from 2022 and 188 samples from 2023) were selected for additional testing and 14 samples (14/370; 4%) were positive for Enteroviruses. Of note, EV-D68 was not detected. In this study, we report a high prevalence of RV/EV which is consistent with the higher detection rate in the fall seasons, when our samples were collected. The low prevalence of EV suggests a high prevalence of RV, although this was not tested. Despite a nationwide surge in the USA in 2022, there was no EV-D68 circulating in these patients. Further analysis, using Whole genome sequencing of the enteroviruses detected in this study will provide additional information on specific circulating Enterovirus genotypes.

Barriers to Kidney Transplantation in the Largest Safety Net Hospital in New York: A Quality Improvement Project

Barriers to Kidney Transplantation in the Largest Safety Net Hospital in New York: A Quality Improvement Project

Evaluation of the Implementation of Low-Low Hospital Beds With Respect to Fall Frequency and Patient Harms: ARetrospective Analysis.

To identify whether the introduction of low-low hospital beds resulted in changes in the incidence, associated patient harms and event characteristics of bed-related falls where implemented. This retrospective quality improvement study covered 36 months: 18 months pre-intervention and 18 months post-intervention. Our analysis incorporated patient fall data from a hospital in upstate New York. Pre-/post-intervention data covered 18 months on either side of introduction at the units of implementation. Data were sourced from contemporaneously recorded incident reports and the organisation's business intelligence records. Analysis addressed the incidence rate, frequency, patient harm classification and recurrence of bed-related falls, as well as Morse Fall Scale risk classification, patient age, gender and other individualised risk factors. Lastly, we reviewed the presence of individualised interventions, staff assistance during the event, patient census and staffing ratios. Chi-square goodness of fit tests were employed to compare the distribution, and Brunner-Munzel tests the stochastic equality, of the pre- and post-implementation categorical and continuous data. There were no significant differences in the incidence rate of bed-related falls, patient harms or in the need for medical intervention following implementation of the low-low hospital beds. Neither were there any significant differences in the proportion of events resulting in detectable harm or the need for medical intervention post-implementation. The total number of bed-involved falls substantively increased following implementation of the low-low beds, as did the number of events resulting in detectable harms and medical intervention. Among these, substantive increases were noted among events resulting in minor temporary harm and patients referred for diagnostic imaging. The number of events involved patients experiencing recurrent falls of any kind increased significantly post-implementation. We found that the introduction of low-low hospital beds preceded no change in the incidence of bed-related falls, associated patient harms or the need for post-event medical intervention where implemented. While data limitations precluded definitive determination with respect to certain event characteristics, several post-implementation changes, including substantive increases in the number of falls occurring during ingress and egress, may suggest a potential for relationship worthy of future study. Low-low hospital beds are purported to help reduce the occurrence and severity of bed-related falls, both serious problems in inpatient settings. This study describes null outcomes following an implementation of such beds, with implications for adoption in similar settings. We adhered to the relevant Enhancing the Quality and Transparency of Health Research guidelines, specifically following the Standards for Quality Improvement Reporting Excellence standards. No patient or public involvement in the design or conduct of the study. Nurses and medical staff were involved in intervention implementation, data collection and the conception, design and conduct of the study.

Premorbid Incidence of Mental Health and Substance Abuse Disorders in Facial Trauma Patients

Study Design A retrospective study. Objective Facial trauma is a prevalent cause of morbidity and mortality with increasing incidence over recent decades. Few studies have examined the prevalence of mental health and substance abuse disorders at the time of diagnosis. Herein we investigate the psychosocial demographics associated with facial trauma. Methods The 2016 State Inpatient Database (SID) was used to identify patients with facial trauma from all hospitals in New York, Florida, and Maryland. A non-trauma control group undergoing elective same-day surgeries at ambulatory surgical centers in Florida, Kentucky, Nevada, North Carolina, New York, and Maryland was identified using the State Ambulatory Surgery and Services Database (SASD) from the Healthcare Cost and Utilization Project (HCUP). 777 patients were identified with facial trauma and compared to 500 patients without facial fractures. Results Patients with facial fractures were statistically significantly more likely to have a substance abuse disorder (OR 34.78, P < .001) or mental health disorder (OR 2.75, P < .001) compared to controls. Patients with facial fractures were significantly more likely to be black than white (OR 4.80, P < .001). Patients with facial fractures were significantly more likely to have Medicaid compared to Medicare (OR 2.12, P = .005). Conclusions Patients with facial fractures are more likely to have premorbid substance abuse and mental health disorders as compared to controls.

Social vulnerability and prenatal diagnosis.

There are limited data on how neighborhood-level risk factors affect the likelihood of having prenatal diagnosis. Neighborhood social vulnerability can be quantified and ranked using the social vulnerability index (SVI), a tool that measures the cumulative effect of external stressors in the local environment that may affect health outcomes. The objective of the study was to determine the relationship between SVI and prenatal diagnosis among pregnant patients who received genetic counseling. Retrospective cohort study of all pregnant patients who had genetic counseling at two hospitals in New York between January 2019 and December 2022. For each patient, the address of residence was linked to an SVI score (primary exposure) based on census tract. SVI scores were subdivided into fifths and analyzed categorically. The primary outcome was prenatal diagnosis (yes/no). Multivariable logistic regression was performed. A total of 5,935 patients were included for analysis and 231 (3.9 %) had prenatal diagnosis. On regression analysis, no association between SVI and prenatal diagnosis wasobserved. Patients who had a diagnostic procedure weremore likely to be English speaking (aOR 1.80; 95 % CI 1.13-2.87), carriers of a genetic disorder (aOR 1.94; 95 % CI 1.32-2.86), had increased NT (aOR 6.89; 95 % CI 3.65-13.00), abnormal NIPS (aOR 9.58; 95 % CI 5.81-15.80), or had fetal structural anomalies (aOR 10.60; 95 % CI 6.62-16.96). No differences were seen based on race and ethnicity group, insurance type, or marital status. SVI score does not affect rate of prenatal diagnosis. Findings may differ in other geographic regions and populations.

Improving Time to Antibiotics in Patients with Long Bone Open Fractures Presenting to the Pediatric Emergency Department.

To evaluate a new triage workflow aimed at improving time to intravenous antibiotics in open fractures to under 60 minutes of arrival to the Pediatric Emergency Department. Design: A prospective, multi-disciplinary, quality improvement project. A tertiary care, Level 1 Pediatric Trauma hospital in New York. Patients aged 17 and under with long bone open fractures between June 1, 2020 and May 31, 2021, excluding those transferred from an outside hospital, with non-long bone fractures and non-fractured, injured extremities.Outcome Measures and Comparisons: The new workflow involved splint removal and skin assessment during triage to identify open fractures. Serial Plan-Do-Study-Act (PDSA) cycles aimed to refine this workflow and reduce antibiotic administration time. Primary outcome: Percentage of open fracture patients receiving intravenous (IV) antibiotics within 60 minutes. Secondary outcome: Assessment of triage documentation regarding splint presence and removal. An exact Wilcoxon two-sample test compared time from patient arrival (quick-registration) to antibiotic administration before, during and after workflow implementation on 6/1/2020. A total of 51 patients (33 male) aged 17 and under, with open fractures were reviewed: 25 during the pre-intervention phase 1/1/18-5/31/20, 14 during the intervention phase 6/1/20-5/31/21, and 12 during the post-intervention phase 6/1/21-11/30/21. Continuous improvement efforts via PDSA cycles focusing on education, reinforcement, recognition, and barrier identification increased the percentage of patients receiving antibiotics within 60 minutes from 36% to 87.5%. Median time and Interquartile range (IQR: 25th percentile-75th percentile) from quick-registration to administration was 86 minutes (IQR: 51-147) before 6/1/2020, and 34 minutes (IQR: 16- 42) thereafter. The implemented triage workflow led to improved time to antibiotics to within 60 minutes for patients with long bone open fractures in the Pediatric Emergency Department. Level III. See Instructions for Authors for a complete description of levels of evidence.

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

Medications for opioid use disorder (MOUD) are highly effective, but only 22% of individuals in the US with opioid use disorder receive them. Hospitalization potentially provides an opportunity to initiate MOUD and link patients to ongoing treatment. To study the effectiveness of interprofessional hospital addiction consultation services in increasing MOUD treatment initiation and engagement. This pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) trial was conducted in 6 public hospitals in New York, New York, and included 2315 adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Data analysis was conducted in December 2023. Hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Bayesian analysis accounted for the clustering of patients within hospitals and open cohort nature of the study. The addiction consultation service intervention was compared with TAU using posterior probabilities of model parameters from hierarchical logistic regression models that were adjusted for age, sex, and study period. Eligible participants had an admission or discharge diagnosis of opioid use disorder or opioid poisoning/adverse effects, were hospitalized at least 1 night in a medical/surgical inpatient unit, and were not receiving MOUD before hospitalization. Hospitals implemented an addiction consultation service that provided inpatient specialty care for substance use disorders. Consultation teams comprised a medical clinician, social worker or addiction counselor, and peer counselor. The dual primary outcomes were (1) MOUD treatment initiation during the first 14 days after hospital discharge and (2) MOUD engagement for the 30 days following initiation. Of 2315 adults, 628 (27.1%) were female, and the mean (SD) age was 47.0 (12.4) years. Initiation of MOUD was 11.0% in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program vs 6.7% in TAU, engagement was 7.4% vs 5.3%, respectively, and continuation for 6 months was 3.2% vs 2.4%. Patients hospitalized during CATCH had 7.96 times higher odds of initiating MOUD (log-odds ratio, 2.07; 95% credible interval, 0.51-4.00) and 6.90 times higher odds of MOUD engagement (log-odds ratio, 1.93; 95% credible interval, 0.09-4.18). This randomized clinical trial found that interprofessional addiction consultation services significantly increased postdischarge MOUD initiation and engagement among patients with opioid use disorder. However, the observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment. ClinicalTrials.gov Identifier: NCT03611335.

Rockland State Hospital: A Case Approach to Teaching the History of Psychology

Background: Teaching and learning about the history of the profession is consistent with APA's 2023 guidelines for the undergraduate major, a profession-wide competency for graduate students in health service psychology, and important for all students. Objective: The purpose of this article is to present a historical case study with materials for teaching and learning about the historical context, including mental health treatments and patient demographics, during the interwar period at Rockland State Hospital (RSH) in New York. Method: We thematically reviewed and analyzed primary source archival documents, treatment reports, period peer-reviewed journals, related newspaper articles, and publicly available U.S. census data. Results: The theories, diagnostic terminology, and treatments in use at RSH during the interwar period are showcased. This was a pivotal time in the history of psychology. Conclusion: The method and results offer opportunities for teaching and learning about the history of psychology including treatment of marginalized and vulnerable populations. Teaching Implications: Institutionalization in the interwar period offers multiple opportunities for teaching and learning in psychology. The findings can be used in conjunction with discussion questions in the classroom setting. Teaching about the past provides a feedback loop to inform current and future practice.

Institutional Guideline May Not Be Enough to Change Practice in the Management of Traumatic Hemothorax (HTX) and Pneumothorax (PTX) Management

Traumatic hemothorax and pneumothorax (HTX/PTX) are traditionally treated with large-bore chest tubes, which can lead to pain and complications. Recent studies suggest pigtail catheters can be utilized as a non-inferior alternative. The Departments of Surgery and Emergency Medicine at NewYork Presbyterian – Weill Cornell Medical Center developed an institutional guideline to standardize tube size for treating traumatic HTX/PTX, aiming to reduce the use of large-bore thoracotomy tubes without causing adverse patient outcomes. This project at NYP-WCM included patients over 18 years of age admitted with thoracic injuries resulting in HTX or PTX treated with a chest tube from January 2022 to November 2023. Patients were identified through ICD codes in the trauma registry and electronic medical record. The primary outcome was adherence to the newly developed guideline for placing thoracostomy tubes. Conversion from pigtail to larger-bore chest tube and other adverse events were secondary outcomes. We identified 18 pre-guideline and 27 post-guideline HTX/PTX patients meeting the criteria. Before the guideline implementation, 15 out of 18 patients (83%) received care consistent with the guideline (no large-bore chest). After implementation, 25 out of 27 patients (93%) received care consistent with the guideline. Based on chart review, none of the patients in the pigtail cohort experienced complications or required conversion to a larger chest tube. Although the impact was modest, implementation of the institutional guideline correlates with a reduction in “unnecessary” large-bore chest tubes for treating traumatic HTX/PTX and showed a trend toward pigtail adoption. Placement of pigtails was not linked to negative complications or treatment failure, indicating a non-inferior safety and effectiveness profile for addressing traumatic HTX/PTX.

Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional study

BackgroundDuring the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths. ObjectiveTo determine whether hospital differences in pre-pandemic and during pandemic nursing resources—average patient-to-registered nurse (RN) staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition—explain differences in risk-adjusted Covid-19 mortality; and to estimate how many deaths may have been prevented if nurses were better resourced prior to and during the pandemic. MethodsThis is a cross-sectional study of 87,936 Medicare beneficiaries (65–99 years old) hospitalized with Covid-19 and discharged (or died) between April 1 and December 31, 2020, in 237 general acute care hospitals in New York and Illinois. Measures of hospital nursing resources (i.e. patient-to-RN staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition) in the pre-pandemic period (December 2019 to February 2020) and during (April to June 2021) were used to predict in-hospital and 30-day mortality using adjusted logistic regression models. ResultsThe mean age of patients was 78 years (8.6 SD); 51 % were male (n = 44,998). 23 % of patients admitted to the hospital with Covid-19 died during the hospitalization (n = 20,243); 31.5 % died within 30-days of admission (n = 27,719). Patients admitted with Covid-19 to hospitals with better nursing resources pre-pandemic and during the pandemic were statistically significantly less likely to die. For example, each additional patient in the average nurses' workload pre-pandemic was associated with 20 % higher odds of in-hospital mortality (OR 1.20, 95 % CI [1.12–1.28], p < 0.001) and 15 % higher odds of 30-day mortality (OR 1.15, 95 % CI [1.09–1.21], p < 0.001). Hospitals with greater proportions of BSN-qualified RNs, better quality nurse work environments, and Magnet recognition offered similar protective benefits to patients during the pandemic. If all hospitals in the study had superior nursing resources prior to or during the pandemic, models estimate many thousands of deaths among patients hospitalized with Covid-19 could have been avoided. ConclusionsPatients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.

Characterizing "collateral damage" in men and women with metastatic breast cancer (mBC) from diverse racial and ethnic backgrounds in New York City.

Patients from diverse racial, ethnic, and socio-economic backgrounds may be particularly vulnerable to experiencing undue social and financial burdens ("collateral damage") from a metastatic breast cancer (mBC) diagnosis; however, these challenges have not been well explored in diverse populations. From May 2022 to May 2023, English- or Spanish-speaking adults with mBC treated at four New York-Presbyterian (NYP) sites were invited to complete a survey that assessed collateral damage, social determinants of health, physical and psychosocial well-being, and patient-provider communication. Fisher's exact and the Kruskal-Wallis rank-sum tests assessed differences by race and ethnicity. 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. While 100% of Hispanic, NHW, and AAPI participants reported stable housing, 29% of NHB participants were worried about losing housing (p = 0.002). Forty-two percent of Hispanic and 46% of NHB participants (vs. 8%, NHW and 0%, AAPI, p = 0.005) 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 = 0.033). Participants were generally satisfied with the quality of communication that they had with their healthcare providers and overall physical and mental well-being were modestly poorer relative to healthy population norms. In our study, NHB and Hispanic mBC patients reported higher levels of financial concern and were more likely to experience food and transportation insecurity compared to NHW patients. Systematically connecting patients with resources to address unmet needs should be prioritized to identify feasible approaches to support economically vulnerable patients following an mBC diagnosis.

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

Oropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes. To determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia. This cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium). Hospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS). Of 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91). This cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.

Telemedicine critical care availability and outcomes among mechanically ventilated patients

PurposeTelemedicine Critical Care (TCC) improves adherence to evidence based protocols associated with improved mortality among patients receiving invasive mechanical ventilation (IMV). We sought to evaluate the relationship between hospital availability of TCC and outcomes among patients receiving IMV. Materials and methodsWe performed a cross-sectional study of 66,522 adults who received IMV for non-postoperative acute respiratory failure at 318 non-federal hospitals in New York, Massachusetts, Maryland, and Florida in 2018. Hospital-level TCC availability was ascertained from the 2018 American Hospital Association Annual Survey. The primary outcome was in-hospital mortality. Secondary outcomes included the composite of tracheostomy or reintubation and duration of IMV. We used two-level hierarchical multivariable regression models to investigate the association between TCC availability and outcomes. Results20,270 (30.5%) patients were admitted into 89 TCC-available hospitals. There was no difference between TCC and non-TCC-available hospitals in mortality (odds ratio [OR] 0.94, 99% confidence interval [CI] 0.84–1.05), composite of tracheostomy or reintubation (OR 0.95 [0.82–1.11], or duration of IMV (OR 0.95 [0.83–1.09]). There was no difference in outcomes among the subgroup of patients with acute respiratory distress syndrome. ConclusionsHospital TCC availability was not associated with improved outcomes among patients receiving IMV.

A secondary gendered analysis of interviews with Latina cisgender women indicated for HIV pre-exposure prophylaxis

ABSTRACT HIV infections disproportionately impact Latinx populations in the United States, yet oral pre-exposure prophylaxis (PrEP) uptake is low. This study was a secondary gendered analysis of interviews with Latina cisgender women (n = 20) recruited from an urban safety net hospital inNew York City between August 2019 and October 2022. All women were indicated for PrEP by the provider. In-depth interviews were conducted with participants in English and Spanish and asked about social determinants of health, sexual partnerships and behaviors, and PrEP-specific enablers and barriers. Secondary thematic content analysis was conducted to identify gender-related factors influencing PrEP uptake. The following themes emerged from the data:structural factors (e.g., employment), partner-related factors, low sexual health knowledge, and resilience and empowerment. Partner-related factors were the most salient; partner infidelity served as reasons for initiating PrEP. Despite being constrained by low power in relationships, women made empowered choices to initiate PrEP and protect themselves. Findings indicated that the impact of gender inequity was an important factor in Latina women’s PrEP decision making, pointing to a need to address partner-driven HIV risk, imbalance of power in relationships, and gender norms.

Abstract TP273: Misdiagnosis of Pregnancy-Associated Stroke in the Emergency Department

Introduction: Pregnancy and the postpartum period are associated with an increased risk of ischemic and hemorrhagic strokes. The incidence of missed or delayed diagnosis of pregnancy-associated stroke in the emergency setting is unknown. Methods: We conducted a retrospective cohort study of all women aged 12 years or older who were hospitalized for labor and delivery using deidentified administrative claims data from all nonfederal EDs and hospitals in New York from 2006-2016 and Florida from 2005-2018. In this cohort, we then identified women hospitalized for a cerebrovascular event (either ischemic or hemorrhagic stroke) using previously validated ICD-9-CM or ICD-10-CM codes during a 270-day period extending from 6 months before through 3 months after delivery. We defined probable ED misdiagnosis of stroke as having an ED treat-and-release visit for neurological complains (e.g., headache, dizziness, numbness) within the 14 days preceding their stroke hospitalization. Logistic regression was used to compare rates of clinical outcomes in pregnant or postpartum stroke patients with and without probable stroke misdiagnosis after adjusting for demographic and vascular risk factors. Results: Among 3,474,960 women hospitalized for labor and delivery, 350 (0.01%) were hospitalized for an ischemic or hemorrhagic stroke during the study period. Out of the 350 pregnant or postpartum women hospitalized for stroke, 17 (4.9%; median age 30) had at least one preceding ED visit for a neurological symptom (probable misdiagnosis). There was no difference in length of stay (4 versus 5 days, p = 0.97), mortality (0% versus 3.6%, p = 1.00), and discharge to home (70.6% versus 57.1%, p = 0.27) after stroke hospitalization between patients with versus without a probable ED misdiagnosis. Conclusion: Probable ED misdiagnosis occurred in nearly 1 of 20 cases of pregnancy-associated stroke in a large, multistate cohort. However, misdiagnosis was not associated with increased length of stay, higher mortality, or lower rates of discharge to home after stroke.

INCREASING ACCESS TO INTERDISCIPLINARY IBD CARE FOR NEWLY DIAGNOSED IBD PATIENTS USING TELEMEDICINE: AN EXTENSION OF THE COMPASS-IBD PROGRAM

Abstract INTRODUCTION Interdisciplinary care is increasingly being recognized as important in the care of inflammatory bowel disease (IBD) patients. However, access to additional resources to do this are frequently only available in tertiary-care IBD centers. We piloted a telemedicine version of an interdisciplinary care program for recently diagnosed IBD patients. METHODS The Mount Sinai Health system has a well-established IBD center, located at the Mount Sinai Hospital in New York. Patients who were diagnosed with IBD in the last 18 months were identified by a primary gastroenterologist working at a community site within the Mount Sinai health system. Once identified, patients were referred electronically and enrolled in the Comprehensive Care for the Recently Diagnosed IBD Patient (COMPASS-IBD) program. This existing program provides interdisciplinary care to newly diagnosed IBD patients. IBD patients have access to a physician who works at the IBD Center, a nutritionist specializing in IBD diets, an experienced IBD clinical pharmacist and a licensed clinical social worker dedicated to the mental and social needs of patients with IBD. After an initial assessment, these patients were then provided access as needed to the program experts. All appointments were done virtually using telemedicine. After completing intake, recommendations were consolidated and provided to the patient and the patient’s primary gastroenterologist electronically. The patient then followed up with his/her primary gastroenterologist. RESULTS For this pilot study, twelve newly diagnosed inflammatory bowel disease patients were identified at community sites within the Mount Sinai health system. Enrolled patients met with all members of the COMPASS- IBD program team for their initial intake. The referring gastroenterologist received summary recommendations for all patients who completed the intake. Participating patients were overall satisfied with the intervention and use of telemedicine as a primary modality. No major barriers to virtual program implementation were identified. DISCUSSION We demonstrated the feasibility of providing interdisciplinary care via telemedicine for recently diagnosed IBD patients. This supports a “hub and spoke” model for IBD care. We believe our pilot study shows a simple way for health systems to increase access to interdisciplinary IBD care for patients with limited access to tertiary-care IBD Centers. This approach may also help in achieving health equity for underserved IBD patient populations.

Home-based cognitive bias modification training for reducing maladaptive fear in patients with suspected acute coronary syndrome: a pilot randomized clinical trial

BackgroundPatients evaluated in an emergency department for suspected acute coronary syndromes (ACS; e.g., myocardial infarction) often experience a lingering fear of recurrence, which may adversely affect their mental health and adherence to recommended health behaviors. Cognitive bias modification training (CBMT) is an acceptable, easy-to-use intervention that reduces fear of recurrence in cancer patients, and reduces fear and anxiety in other populations, providing an alternative to psychotherapy or counseling-based approaches. Feasibility testing is needed to assess whether a cardiac-related version of CBMT is acceptable to patients with elevated threat perceptions related to their suspected ACS.MethodsWe developed a tablet-based CBMT intervention tailored to reduce cardiac-related fear of recurrence. In this double-blinded feasibility trial, patients with elevated threat perceptions related to a recent suspected ACS were randomized either to a 4-week, 8-session, tablet-delivered intervention (CBMT) group or to a sham attention control group. Feasibility outcomes included the proportion of eligible patients who enrolled, drop-out rate, intervention compliance rate, acceptability/pleasantness and usability ratings, and task engagement (i.e., accuracy, response time).ResultsOf 49 eligible patients with suspected ACS and elevated threat perceptions recruited from NewYork-Presbyterian Hospital, over half (53.1%) enrolled after receiving a description of study procedures. Of the 26 randomized patients (mean age 59.15 years, 50% women), 2 patients (7.7%) dropped out. Additionally, 4 (15.4%) enrolled patients were not able to complete the tablet tasks, either due to difficulties with the technology or an inability to process the visually presented linguistic information at a sufficient speed. Still, among patients who returned the tablets (19 returned/20 received; 95%), most completed all assigned tablet tasks (intervention or control; 10/19; 52.6%), reporting that the tablets were easy to use and that the tasks were pleasant to complete.ConclusionCurrent findings suggest that cardiac-related CBMT is a promising and generally acceptable intervention for suspected ACS patients with cardiac-related threat perceptions which are akin to fear of recurrence. Nevertheless, challenges related to tablet usage indicate that the intervention user-experience should be further refined to optimize usability.Trial registrationRegistered at ClinicalTrials.gov on 2/25/2019; NCT03853213. Registered with the Open Science Framework on 11/20/2017; https://osf.io/k7g8c/.

Psychosocial support among adults living with metastatic breast cancer: Perspectives from providers across four New York-Presbyterian hospitals.

Key Points We conducted semi‐structured interviews with providers at four New York‐Presbyterian (NYP) hospitals: Weill Cornell Medicine (WCM), NYP‐Queens, NYP‐Brooklyn Methodist Hospital, and Columbia University Medical Center. Emergent themes identified factors that influenced healthcare delivery at the institutional, provider, and patient levels. Most frequently reported barriers included a lack of formal protocols for communicating and offering psychosocial resources to patients (institutional), lack of vital staff such as, social workers and patient navigators (institutional), time constraints (provider), and stigma regarding mental health care (patient). Most frequently cited facilitators to delivering psychosocial care included having a trained social worker on staff (institutional), awareness of psychosocial needs (provider), and engagement (patient). Our findings highlight opportunities to improve the provision of psychosocial care for adults with metastatic breast cancer (mBC) at multiple levels.

Ramón Castroviejo (1904–1987): The father of the modern corneal transplantation

Ramón Castroviejo Briones was born in 1904 in Logroño, Spain. He received his medical education at the University of Madrid, where he graduated in 1927. In 1929, he received a fellowship to work as assistant in the Ear, Nose, and Throat Hospital and College of Chicago. In 1930, he passed his American Board Examination and returned to Europe to visit the centers where keratoplasty was a fact. He visited the University eye clinics of Madrid, Paris, Vienna, Berlin, and Prague. When he returned to the United States, Castroviejo had a clear idea of what was being done in Europe and what he hoped to achieve. William L. Benedict had offered him a research fellowship at the Mayo Clinic, in Rochester, Minnesota, which Castroviejo accepted. In 1932, Dr. Maynard C. Wheeler granted Castroviejo a Research Fellowship at the new Eye Institute of the College of Physicians and Surgeons of Columbia University. He moved to New York, where he continued his research in animals in the Eye Institute of the Columbia Presbyterian Medical Center, and was an early developer of techniques for transplanting corneal tissue from the eyes of those who had just died to damaged eyes of the living. While not being the first to successfully graft human cornea, he improved the technique of the operation in the 1930s and 1940s, prompting the worldwide adoption of corneal transplantation as a standard way to deal with severe corneal pathology. His keratoplasty technique, creating a rectangular rather than circular “window” in the cornea, was the secret to his successful transplants, and remained standard until more efficient suture materials became available. The surgeon described this technique in 1937 to the American College of Surgeons. He contended that rectangular windows gave better results than the circular ones that had been tried earlier, since their edges could be fitted better to merge with and become a living part of the rest of the eye. Although the medical community was slow to recognize his successes, Castroviejo was eventually lauded for his sight‐saving corneal tissue transplant techniques, which he continued to refine and teach for many years. Castroviejo also promoted the donation of corneal tissue in the United States and designed numerous ophthalmic instruments, including the Castroviejo needle holder ‐an instrument used in eye, dental and other forms of microsurgery‐ Castroviejo callipers and corneal scissors. He became the director of Ophthalmology at St. Vincent's Hospital before he opened his own hospital when he bought the Hammond House in New York. After closing his private hospital he retired as clinical professor of the University of New York and moved permanently to Madrid, where he founded the Instituto Castroviejo, at the Complutense University of Madrid, and organized the Spanish Eye Bank, maintaining extensive clinical activity whenever his health permitted. Ramón Castroviejo died in 1987, at the age of 82, and is widely recognized as one of the 10 most influential people in ophthalmology of the 20th century.

BRINGING GERIATRIC CARE INTO THE HIV PRIMARY CARE CLINIC: A COMBINED HIV/GERIATRIC MULTIDISCIPLINARY CLINIC MODEL

Abstract Persons living with HIV (PLWH) experience accelerated and accentuated aging, developing co-morbidities at earlier ages and with higher frequencies than those without HIV. Older persons with HIV (OPWH) also experience geriatric syndromes. In 2020 we developed a combined HIV/geriatrics multidisciplinary clinic at Mount Sinai Hospital in New York where a geriatrician and multidisciplinary team including a nurse, pharmacist, and social worker are embedded in an HIV primary care clinic. Patients are referred for comprehensive geriatric assessments. We conducted a retrospective chart review after the first 15 months of the program to describe this population of OPWH living in NYC who are referred to a geriatrician. From 9/2020-11/2021, there were 183 appointments scheduled of which 112 (61%) were new patient visits. Sixty-two percent of patients came to their appointment. The average age of patients was 67 years. Fifty-seven percent identified as male. The majority of referrals (50%) were for cognitive assessment followed by mobility assessment (25%), polypharmacy (14%), multimorbidity (8%), advance care planning (1%), and other (2%). Based on this data, we identified a need to improve the show rate to our clinic and implement cognitive screening in OPWH. We have incorporated a community health worker into our interdisciplinary team to assist in this goal and continue to educate patients and providers on geriatric syndromes. A geriatric approach to care is crucial to incorporate into existing HIV clinical practices and we hope to optimize this integration based on the needs of patients and providers.