New York Hospital Research Articles

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer.

Poor women with breast cancer have worse survival than others, and are more likely to undergo surgery in low-volume facilities. We leveraged a natural experiment to study the effectiveness of a policy intervention undertaken by New York (NY) state in 2009 that precluded payment for breast cancer surgery for NY Medicaid beneficiaries treated in facilities performing fewer than 30 breast cancer surgeries annually. We identified 37,822 women with stage I-III breast cancer during 2004-2008 or 2010-2013 and linked them to NY hospital discharge data. A multivariable difference-in-differences approach compared mortality of Medicaid insured patients with that of commercially or otherwise insured patients unaffected by the policy. Women treated during the postpolicy years had slightly lower 5-year overall mortality than those treated prepolicy; the survival gain was significantly larger for Medicaid patients (P = .018). Women enrolled in Medicaid had a greater reduction than others in breast cancer-specific mortality (P = .005), but no greater reduction in other causes of death (P = .50). Adjusted breast cancer mortality among women covered by Medicaid declined from 6.6% to 4.5% postpolicy, while breast cancer mortality among other women fell from 3.9% to 3.8%. A similar effect was not observed among New Jersey Medicaid patients with breast cancer treated during the same years. A statewide centralization policy discouraging initial care for breast cancer in low-volume facilities was associated with better survival for the Medicaid population targeted. Given these impressive results and those from prior research, other policymakers should consider adopting comparable policies to improve breast cancer outcomes.[Media: see text].

Abstract C009: Race- and TNBC-specific circulating biomarker profiles among breast cancer patients

Abstract Triple negative breast cancer (TNBC) is the most aggressive molecular subtype of BC, with no targeted therapeutics currently available and poor systemic treatment response among certain patient groups. Cytokines, chemokines and adipokines are cell signaling molecules that play significant roles in mediation of inflammation/immune response in tumorigenesis and cancer progression. Relative systemic levels of these molecules secreted from the BC tumor microenvironment may be developed as prognostic liquid biopsy biomarkers. At present, we have investigated race-specific and TNBC-specific differences in circulating biomarker profiles of AA (n = 65) and EA (n = 88) BC patients. The International Center for the Study of Breast Cancer Subtypes (ICSBCS) maintains a prospective cohort biorepository of African and US patients, including patients from Detroit, MI (Henry Ford Health System) and New York City, NY (NewYork Presbyterian Hospitals). Using a multiplexed bead-based ELISA platform (Luminex®) we quantified the relative plasma levels of 45 different biomarkers per manufacturer’s protocols. Normalization of plate/batch effect was completed using MDimnNormn, and statistical tests were completed with JMP Pro 16. There were no significant differences between groups across most clinicopathological variables; including, age (p = 0.86), tumor histology (p = 0.45), subtype (p = 0.4039) or stage (p = 0.20). However, BMI was significantly higher among AA patients compared to EA patients (AA mean 31.5, EA mean 28.7, p = 0.016), and multivariate analyses were adjusted for BMI. Histological subtypes and stage represented a cross section of the cohort, with the majority being invasive ductal (AA 70.8%, EA 71.6%), and early-stage (Stage I and II) disease (AA 83.1%, EA 80.7%). The predominant intrinsic subtype is LumA (AA 69.2%, EA 67%), with a relatively higher proportion of TNBC disease among AA (20%) compared to EA patients (10.2%) (p = 0.086). Our univariate/unadjusted SRR-association models identified four biomarkers: IFNg (p = 0.022), I-TAC/CXCL11 (p = 0.003), MDC/CCL22 (p = 0.041) and MIPa/CCL3 (p = 0.038), which were higher among AA compared to EA patients. After controlling for BMI as a covariate in our model, all markers retained significance, with IFNg, I-TAC/CXCL11 and MIPa/CCL3 being p < 0.05, and MDC/CCL22 with slightly lower significance (p = 0.054). To determine TNBC-specific profiles we compared biomarkers between TNBC (n = 22) and non-TNBC (n = 131) patients. The unadjusted/univariate analysis yielded no associations. However, after adjusting for BMI and SRR, 10 circulating biomarkers were significantly higher among patients with TNBC: IL16, MIF, TNFa, MPIF1/CCL23, IL1b, Gro-a/CXCL1, SCYB16/CXCL16, ENA-78/CXCL5, Fractalkine/CX3CL1 and Leptin (p < 0.05). Taken together, these findings highlight that there are distinct SRR- and TNBC- circulating biomarker profiles, that may elucidate functional distinctions across TNBC patients to provide biomarkers for novel prognostic or therapeutic opportunities for patients. Citation Format: Rachel Martini, Millicent Amankwah, Julie Sahler, Brian Stonaker, Mumina Sadullozoda, Peter Radzio, Avery August, Lisa Newman, Melissa Davis. Race- and TNBC-specific circulating biomarker profiles among breast cancer patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C009.

254: TELEMEDICINE CRITICAL CARE AVAILABILITY AND OUTCOMES AMONG MECHANICALLY VENTILATED PATIENTS

Introduction: Mechanical ventilation (MV) interventions like low tidal volume ventilation and daily spontaneous awakening and breathing trials are associated with improved survival but are unevenly implemented in real-world practice. Telemedicine Critical Care (TCC) improves adherence to these interventions. Whether or not hospitals with TCC have better MV outcomes than hospitals without TCC is unknown. We evaluated the association of hospital availability of TCC and outcomes among MV patients. Methods: We analyzed 19,679 adult non-surgical, mechanically ventilated patients in an Intensive Care Unit (ICU) in 2018 at 310 non-federal State Inpatient Database hospitals in Florida, Massachusetts, Maryland, and New York. The primary predictor variable was availability of TCC at a study hospital. The primary outcome was mortality defined as hospital death or discharge to hospice. Secondary outcomes were a composite of tracheostomy or re-intubation and duration of mechanical ventilation. We used a two-level hierarchical multivariable logistic regression model to investigate whether TCC availability was associated with study outcomes. Results: Among 19,679 mechanically ventilated patients, 6,177 (31.4%) occurred in TCC hospitals. Compared to non-TCC hospitals, TCC hospitals had reduced but insignificant odds of mortality (odds ratio [OR] 0.97, 95% CI 0.85–1.09), composite of tracheostomy/re-intubation (OR 0.93 [0.78–1.0]), and duration of mechanical ventilation (OR 0.95 [0.85-1.07]). Hospital size and annual mechanical ventilation case volume did not modify the association between TCC availability and mortality (P=0.75 and P=0.44 for interactions, respectively). Conclusions: Hospital availability of TCC was not associated with lower odds of mortality among mechanically ventilated patients.

Impact of Fluoroquinolone Prophylaxis on Neutropenic Fever, Infections, and Antimicrobial Resistance in Newly Diagnosed AML Patients.

Fluoroquinolone prophylaxis is recommended during induction chemotherapy for patients with acute myeloid leukemia (AML) to reduce risk of neutropenic fever and systemic bacterial infections. We evaluated the effectiveness of primary fluoroquinolone prophylaxis in an area with high fluoroquinolone resistance. We performed a retrospective chart review of newly diagnosed adult AML patients who received frontline therapy at Mount Sinai Hospital in New York, NY, between 2012 and 2019. Primary outcome was development of neutropenic fever. Secondary outcomes were development of systemic bacterial infections and infections with multidrug-resistant organisms and Clostridioides difficile. Infectious outcomes were collected through 6 months after therapy initiation. We estimated the effect of fluoroquinolone prophylaxis with a time-dependent Cox proportional hazards model. Of 121 included patients, 87 received antibiotic prophylaxis and 34 did not. There was no difference in baseline characteristics, although the prophylaxis group had longer neutropenia duration (median 30 vs. 23 days, P=.013). The prophylaxis group had a reduced risk of neutropenic fever (hazard ratio 0.59, P=.039). The prophylaxis group had fewer gram-positive (P=.043) and gram-negative (P=.049) bloodstream infections and fewer clinically documented infections during frontline therapy (P=.005) and follow-up (P=.026). There was no difference in incidence of C. difficile or infection with fluoroquinolone-resistant or multidrug-resistant organisms. There was no mortality difference between groups. In an area with high fluoroquinolone resistance, primary fluoroquinolone prophylaxis in newly diagnosed AML patients reduced the risk of neutropenic fever and systemic bacterial infections without increased antimicrobial resistance. Prospective, randomized studies are needed to confirm these observations.

Assessing burnout among Obstetrics & Gynecology residents during night float versus day float in a large academic hospital

BackgroundThe prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout.ObjectiveTo determine the rates of burnout among residents working night rotations versus day rotations.MethodsThis is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory – Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test.ResultsA total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17 ± 9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18 ± 14) on nights (p = 0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights.ConclusionsEmotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.

Rethinking Surge Preparedness After COVID-19: Effective Patient Load Balancing Within Health Systems and Beyond.

Within weeks of New York State's first confirmed case of COVID-19, New York City became the epicenter of the nation's COVID-19 pandemic. With more than 80,000 COVID-19 hospitalizations during the first wave alone, hospitals in downstate New York were forced to adapt existing procedures to manage the surge and care for patients facing a novel disease. Given the unprecedented surge, effective patient load balancing-moving patients from a hospital with diminishing capacity to another hospital within the same health system with relatively greater capacity-became chief among the capabilities required of New York health systems. The Greater New York Hospital Association invited members of downstate New York's 6 largest health systems to talk about how each of their systems evolved their patient load balancing procedures throughout the pandemic. Informed by their insights, experiences, lessons learned, and collaboration, we collectively present a set of consensus recommendations and best practices for patient load balancing at the facility and health system level, which may inform regional approaches to patient load balancing.

Monitoring the security of audio biomedical signals communications in wearable IoT healthcare

The COVID-19 pandemic has imposed new challenges on the healthcare industry as hospital staff are exposed to a massive coronavirus load when registering new patients, taking temperatures, and providing care. The Ebola epidemic of 2014 is another example of a pandemic which a hospital in New York decided to use an audio-based communication system to protect nurses. This idea quickly turned into an Internet of Things (IoT) healthcare solution to help to communicate with patients remotely. However, it has grabbed the attention of criminals who use this medium as a cover for secret communication. The merging of signal processing and machine-learning techniques has led to the development of steganalyzers with very higher efficiencies, but since the statistical properties of normal audio files differ from those of purely speech audio files, the current steganalysis practices are not efficient enough for this type of content. This research considers the Percent of Equal Adjacent Samples (PEAS) feature for speech steganalysis. This feature efficiently discriminates the least significant bit stego speech samples from clean ones with a single analysis dimension. A sensitivity of 99.82% was achieved for the steganalysis of 50% embedded stego instances using a classifier based on the Gaussian membership function.

Abstract 12148: A New Perspective in the Management of Paroxysmal Atrial Fibrillation: Dual Anti-Arrhythmic Medications

Introduction: Atrial fibrillation is the most common disorder of cardiac rhythm, which is often associated with a high risk of morbidity and mortality. Antiarrhythmic medications (AAMs) continue to be the mainstay in the treatment of paroxysmal atrial fibrillation. However, the use of these medications has been limited by their modest anti-arrhythmic efficacy. Hypothesis: We hypothesized that dual AAMs (sodium/potassium channels blockers) improve the chance of maintaining sinus rhythm and decrease the need for catheter ablation when compared to single AAM. Methods: We conducted a retrospective observational study; we reviewed medical records of 150 patients with paroxysmal atrial fibrillation over five years at our hospital in New York. We collected the following data: age, sex, comorbidities, electrocardiogram findings, ejection fraction by echocardiography, classes of AAMs, duration and response to treatments. A successful response was defined as the absence of symptoms and the presence of sinus rhythm on electrocardiogram. A failed response was defined as persistence of symptoms and/or atrial fibrillation on electrocardiogram and the subsequent need for catheter ablation. Results: 86 patients met the inclusion criteria in our analysis. The average age of the patinets was 71.06 years. 45 patients were given the dual AAMs of either amiodarone+flecainide or dronedarone+flecainide, and were treated for an average of 15.4 months. 41 patients received a single AAM then catheter ablation if needed. A chi-square test was performed. X 2 =18.9429, p<.0001. Patients taking dual AAMs were very likely to maintain sinus rhythm and less likely to need catheter ablation (Figure). Conclusions: Our preliminary results demonstrate that patients who receive dual AAMs are significantly less likely to need catheter ablation than those who receive single AAM. Well-designed prospective studies are needed to further explore the use of dual AAM therapy and its clinical impact.

Abstract 15633: Differences in Atrial Fibrillation Symptoms Post-Ablation by Age

Introduction: The prevalence of atrial fibrillation (AF) increases with age. Although catheter ablation is a recommended treatment for AF and is safe and effective in older adults, symptom outcomes post-ablation have not been well studied among older adults. The objective of this study was to investigate differences in the prevalence of symptoms post-ablation and the need for repeat ablation by age group. Methods: From electronic health records, we used International Classification of Diseases billion codes to identify all patients with an admitting diagnosis of paroxysmal AF who were treated at NewYork-Presbyterian Hospital between 2010 and 2020. We then used Current Procedural Terminology Codes to identify patients who underwent catheter ablation. We extracted age, gender, race, ethnicity, and prevalence of repeat ablations using structured queries. We extracted symptoms post-ablation from unstructured clinical notes using natural language processing. We separated patients into five age groups and evaluated associations between demographics, symptoms, repeat ablations and age group using Chi-square tests. Results: Of the 1,414 patients studied, 34.4% were female and 58.6% were white, and 4.1% were Hispanic or Latino. Significantly more female patients were age 61-80, and significantly more non-White participants were age 51-70, compared to other age groups. There was a clinically but not statistically significant difference in the prevalence of repeat ablations by age, with nearly half of those with repeat ablations being age 61-70. There were no significant differences in symptom prevalence 6 and 12 months post-ablation. Conclusion: A greater proportion of female and non-White patients undergoing ablation are older adults compared to younger or much older (>80 years) patients. There were no differences in repeat post-ablation symptoms by age, suggesting older adults may experience similar symptom reduction following ablations as younger adults.

Unexpected ICU Transfer and Mortality in COVID-19 Related to Hospital Volume.

Coronavirus 2019 (COVID-19) illness continues to affect national and global hospital systems, with a particularly high burden to intensive care unit (ICU) beds and resources. It is critical to identify patients who initially do not require ICU resources but subsequently rapidly deteriorate. We investigated patient populations during COVID-19 at times of full or near-full (surge) and non-full (non-surge) hospital capacity to determine the effect on those who may need a higher level of care or deteriorate quickly, defined as requiring a transfer to ICU within 24 hours of admission to a non-ICU level of care, and to provide further knowledge on this high-risk group of patients. This was a retrospective cohort study of a single health system comprising four emergency departments and three tertiary hospitals in New York, NY, across two different time periods (during surge and non-surge inpatient volume times during the COVID-19 pandemic). We queried the electronic health record for all patients admitted to a non-ICU setting with unexpected ICU transfer (UIT) within 24 hours of admission. We then made a comparison between adult patients with confirmed coronavirus 2019 and without during surge and non-surge time periods. During the surge period, there was a total of 86 UITs in a one-month period. Of those, 60 were COVID-19 positive patients who had a mortality rate of 63.3%, and 26 were COVID-19 negative with a 30.8 % mortality rate. During the non-surge period, there was a total of 112 UITs; of those, 24 were COVID-19 positive with a 37.5% mortality rate, and 90 were COVID-19 negative with a 11.1% mortality rate. During the surge, the mortality rate for both COVID-19 positive and COVID-19 negative patients experiencing an unexpected ICU transfer was significantly higher.

Elevated posaconazole trough concentrations are not associated with increased risk for posaconazole toxicity in lung transplant recipients.

Posaconazole is used for prophylaxis and treatment of invasive fungal infections in lung transplant recipients (LTR). Previous studies have not described the relationship between elevated posaconazole trough concentrations and adverse drug reactions in this population. This IRB-approved, retrospective cohort study at NewYork-Presbyterian Hospital included LTR who had posaconazole trough concentrations measured. The primary aim of this study was to evaluate elevated posaconazole trough concentrations and changes in liver function tests as well as QTc interval. A secondary aim of this study was to identify patient factors associated with elevated posaconazole trough levels. A total of 109 LTR were included. The average age was 58.1years (IQR, 48-65), the majority were male (56%). A total of 932 trough levels were assessed with a median number of 8 (IQR, 5-15) levels per patient. The median posaconazole trough concentration was 1.7mg/L (IQR, 1.1-2.5). Hepatotoxicity, as defined by common terminology criteria for adverse events (CTCAE), was observed in 73.4% of subjects, with the majority classified as grade 1 (67.5%). However, there was no correlation between elevated posaconazole levels and aspartate aminotransferase (r=.03), alanine aminotransferase (r=.04), alkaline phosphatase (r=.04), and total bilirubin (r=.02). There was also no correlation between posaconazole trough concentrations and QTc interval (r=.03). This analysis demonstrates that no correlation exists between whole blood posaconazole levels and hepatotoxicity or QTc prolongation. Based on these results, posaconazole dose reductions may not be warranted for posaconazole levels that are significantly above the therapeutic target to avert risk for hepatotoxicity or QTc prolongation.

Determinates of Clostridioides difficile infection (CDI) testing practices among inpatients with diarrhea at selected acute-care hospitals in Rochester, New York, and Atlanta, Georgia, 2020-2021.

We evaluated the impact of test-order frequency per diarrheal episodes on Clostridioides difficile infection (CDI) incidence estimates in a sample of hospitals at 2 CDC Emerging Infections Program (EIP) sites. Observational survey. Inpatients at 5 acute-care hospitals in Rochester, New York, and Atlanta, Georgia, during two 10-workday periods in 2020 and 2021. We calculated diarrhea incidence, testing frequency, and CDI positivity (defined as any positive NAAT test) across strata. Predictors of CDI testing and positivity were assessed using modified Poisson regression. Population estimates of incidence using modified Emerging Infections Program methodology were compared between sites using the Mantel-Hanzel summary rate ratio. Surveillance of 38,365 patient days identified 860 diarrhea cases from 107 patient-care units mapped to 26 unique NHSN defined location types. Incidence of diarrhea was 22.4 of 1,000 patient days (medians, 25.8 for Rochester and 16.2 for Atlanta; P < .01). Similar proportions of diarrhea cases were hospital onset (66%) at both sites. Overall, 35% of patients with diarrhea were tested for CDI, but this differed by site: 21% in Rochester and 49% in Atlanta (P < .01). Regression models identified location type (ie, oncology or critical care) and laxative use predictive of CDI test ordering. Adjusting for these factors, CDI testing was 49% less likely in Rochester than Atlanta (adjusted rate ratio, 0.51; 95% confidence interval [CI], 0.40-0.63). Population estimates in Rochester had a 38% lower incidence of CDI than Atlanta (summary rate ratio, 0.62; 95% CI, 0.54-0.71). Accounting for patient-specific factors that influence CDI test ordering, differences in testing practices between sites remain and likely contribute to regional differences in surveillance estimates.

A quality assurance initiative on improving cefazolin perioperative redose compliance.

Compliance with perioperative antibiotic prophylaxis is crucial for preventing surgical site infection. Anesthesiologists can play a significant role in reducing surgical site infections by following clinical practice guidelines for antibiotic prophylaxis and redosing during surgery. A quality assurance initiative was implemented at a tertiary hospital with the goal of improving cefazolin perioperative antibiotic compliance. This was a retrospective observational study. Main operating room of a tertiary care teaching hospital in New York, USA. Our main operating room includes 22 operating rooms that incorporates surgeries from general surgery, vascular surgery, neurology, gynecology, urology, orthopedics, ear, nose and throat (ENT) etc. All cases in the main operating room from March 1, 2018 to March 31, 2021 that received first dose of Cefazolin and in which the duration of surgery was more than 4 hrs. A multifaceted intervention was initiated to address low compliance with cefazolin redosing. Multifaceted interventions included the development of a perioperative antibiotic guide for anesthesia providers, automated reminders in anesthesia electronic medical records, grand rounds education, survey and email communications, and regular feedback reports to the anesthesia department. Cefazolin perioperative redose compliance rate. Rates of redose compliance were examined in three time periods: preintervention, intervention and postintervention. Cefazolin redosing compliance was 58% in the preintervention period and 90% in the postintervention period. There was a significant positive change in the trend of compliance during the intervention period, indicating that the odds of compliance increased by 13% per month in the intervention period compared to the preintervention period (odds ratio = 1.13, P < 0.001). Redose compliance improvements were sustained a year after the postintervention period (an average of 91%). Surgical site infection rates for colon, coronary artery bypass graft and hip surgeries did not show any significant trend during these time periods. Multifaceted interventions led to significant and sustained improvements in cefazolin redosing compliance in the main operating room of a tertiary hospital.

Assessing the Variability of Antibiotic Management in Patients With Open Hand Fractures Presenting to the Pediatric Emergency Department.

Open hand fractures may be difficult to recognize and treat. There is variability in management and administration of antibiotics for these types of injuries. Unlike open long bone fractures, there is no standardized protocol for antibiotic administration for open hand fractures in children. The objective of this study is to assess the variability of antibiotic management of open hand fractures in children. We performed a retrospective chart review at a tertiary hospital in New York of patients with hand injuries between ages 0 and 18 years presenting to the emergency department during January 2019 and December 2020. Patient encounters were reviewed for open fractures of the hand. Descriptive statistics were included for demographic and physical characteristics. There were 80 encounters with open hand fractures, of which the most common being tuft fractures (77.5%). The mean age was 7.6 years (SD, 4.7 years) with male predominance (58.8%). Crush injuries were the most common mechanism of injury (78.8%). Bedside repair was performed on 62 encounters (77.5%), of which 45 (72.5%) required nail bed repair, 56 (90.3%) required suturing, and 24 (38.7%) required reduction. Antibiotics were given to 62 (77.5%) encounters, most commonly oral cefalexin (45.2%), oral amoxicillin-clavulanic acid (27.4%), and intravenous cefazolin (14.5%). Median time to antibiotics from emergency department registration to administration was 150 minutes (interquartile range, 92-216 minutes). Antibiotic prescriptions were sent for 71 encounters (88.8%). Seventy seven (96.3%) of the encounters were discharged home. Pediatric open hand fractures have a variability of type and timing to antibiotics. Future initiatives should attempt to create standardized guidelines for management of open hand fractures.

Using patient biomarker time series to determine mortality risk in hospitalised COVID-19 patients: A comparative analysis across two New York hospitals.

A large range of prognostic models for determining the risk of COVID-19 patient mortality exist, but these typically restrict the set of biomarkers considered to measurements available at patient admission. Additionally, many of these models are trained and tested on patient cohorts from a single hospital, raising questions about the generalisability of results. We used a Bayesian Markov model to analyse time series data of biomarker measurements taken throughout the duration of a COVID-19 patient's hospitalisation for n = 1540 patients from two hospitals in New York: State University of New York (SUNY) Downstate Health Sciences University and Maimonides Medical Center. Our main focus was to quantify the mortality risk associated with both static (e.g. demographic and patient history variables) and dynamic factors (e.g. changes in biomarkers) throughout hospitalisation, by so doing, to explain the observed patterns of mortality. By using our model to make predictions across the hospitals, we assessed how predictive factors generalised between the two cohorts. The individual dynamics of the measurements and their associated mortality risk were remarkably consistent across the hospitals. The model accuracy in predicting patient outcome (death or discharge) was 72.3% (predicting SUNY; posterior median accuracy) and 71.3% (predicting Maimonides) respectively. Model sensitivity was higher for detecting patients who would go on to be discharged (78.7%) versus those who died (61.8%). Our results indicate the utility of including dynamic clinical measurements when assessing patient mortality risk but also highlight the difficulty of identifying high risk patients.

Ten Women Who Changed Science and the World

Ten Women Who Changed Science and the World

Long-Term Fine Particulate Matter Concentrations and Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2: Differential Relationships by Socioeconomic Status Among Pregnant Individuals in New York City.

We aimed to determine if long-term fine particulate matter (PM2.5) concentrations are associated with increased risk of testing positive for COVID-19 among pregnant individuals who were universally screened at delivery and if socioeconomic status (SES) modifies this relationship. We used obstetric data from Columbia University Irving Medical Center in New York City from March–December 2020, which included Medicaid use (low-SES surrogate) and coronavirus disease 2019 (COVID-19) test results. We linked 300m resolution estimated 2018-2019 PM2.5 concentrations and census tract-level population density, household size and income, and mobility estimates. Analyses included 3318 individuals; 5% tested positive for COVID-19 at delivery, 8% tested positive during pregnancy, 48% used Medicaid, and average long-term PM2.5 concentrations were 7.4 μg/m3 (SD = 0.8). In adjusted multilevel logistic regression models, we saw no association between PM2.5 and ever-testing positive for COVID-19; however, odds were elevated among those using Medicaid (odds ratio = 1.6, 95% CI 1.0, 2.5 per 1-μg/m3 increase). Further, while only 22% of those testing positive showed symptoms, 69% of symptomatic individuals used Medicaid. SES, including unmeasured occupational exposures or increased susceptibility to the virus due to co-social and environmental exposures, may explain the increased odds of testing positive for COVID-19 confined to vulnerable pregnant individuals using Medicaid.

Predictors of Pediatric Frequent Emergency Department Use Among 7.6 million Pediatric Patients in New York.

This study examines the characteristics and factors associated with frequent emergency department (ED) utilization among the pediatric population. We conducted a pooled cross-sectional secondary analysis using the Healthcare Cost and Utilization Project State Emergency and Inpatient Databases on ED visits to all hospitals in New York from 2011 to 2016 by patients aged 0 to 21. We used multivariable logistic and negative binomial regressions to investigate the predictors of multiple ED visits in the pediatric population. Overall, our study included 7.6 million pediatric patients who accounted for more than 12 million ED visits. Of those, 6.2% of patients were frequent ED users (≥4 visits/year), accounting for 20.8% of all ED visits (5.4 ED visits/year on average). The strongest predictors of frequent ED use were having at least one ED visit related to asthma (aOR=8.37 [95% CI: 6.34-11.04]), mental health disorders (aOR=9.67 [95% CI: 8.60-10.89]), or multiple comorbidities compared to none. Larger shares of ED visits for not-emergent conditions were also associated with frequent ED use (aOR=6.63 [95% CI=5.08-8.65]). Being covered by Medicaid compared to private (aOR=0.45 [95% CI: 0.42-0.47]) or no insurance (aOR=0.41 [95% CI: 0.38-0.44]) were further associated with frequent ED use. The results from the negative binomial regression yielded consistent findings. Pediatric patients who exhibit increased ED use are more medically complex and have increased healthcare needs that are inextricably tied to social determinants of health. Better integrated health systems should emphasize connecting vulnerable patients to appropriate social and primary care services outside of emergency settings.