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N/A. "The Mount Sinai Hospital, New York, Names New President." Journal Of Investigative Medicine 52, no. 02 (2004): 082. http://dx.doi.org/10.2310/6650.2004.17769.
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Harden, Cynthia L. "Introducing New Guidelines on Sudden Unexpected Death in Epilepsy." US Endocrinology 13, no. 02 (2017): 65. http://dx.doi.org/10.17925/use.2017.13.02.65.
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Cynthia L Harden, MD, received her medical degree at the University of Wisconsin. She trained in internal medicine at Mount Sinai St Luke’s Hospital and neurology at Mount Sinai Hospital, both in New York City, and in clinical neurophysiology at Albert Einstein College of Medicine in the Bronx. She served most of her career at Weill Cornell College of Medicine, where she became Professor of Neurology. Dr Harden serves as Chair of the Guideline Development, Dissemination and Implementation Subcommittee of the American Academy of Neurology (AAN). In 2016, she was also elected Chair of AAN’s Epilepsy Section for a 2-year term.
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Harden, Cynthia L. "Introducing New Guidelines on Sudden Unexpected Death in Epilepsy." US Neurology 13, no. 02 (2017): 65. http://dx.doi.org/10.17925/usn.2017.13.02.65.
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Cynthia L Harden, MD, received her medical degree at the University of Wisconsin. She trained in internal medicine at Mount Sinai St Luke’s Hospital and neurology at Mount Sinai Hospital, both in New York City, and in clinical neurophysiology at Albert Einstein College of Medicine in the Bronx. She served most of her career at Weill Cornell College of Medicine, where she became Professor of Neurology. Dr Harden serves as Chair of the Guideline Development, Dissemination and Implementation Subcommittee of the American Academy of Neurology (AAN). In 2016, she was also elected Chair of AAN’s Epilepsy Section for a 2-year term.
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Adams, Annmarie, and Mary Anne Poutanen. "Architecture, Religion, and Tuberculosis in Sainte-Agathe-des-Monts, Quebec1." Scientia Canadensis 32, no. 1 (July 7, 2009): 1–19. http://dx.doi.org/10.7202/037627ar.
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Abstract This paper explores the architecture of the Mount Sinai Sanatorium in Sainte-Agathe-des-Monts (Qc) to disentangle the role of religion in the treatment of tuberculosis. In particular, we analyze the design of Mount Sinai, the jewel in the crown of Jewish philanthropy in Montreal, in relation to that of the nearby Laurentian Sanatorium. While Mount Sinai offered free treatment to the poor in a stunning, Art Deco building of 1930, the Protestant hospital had by then served paying patients for more than two decades in a purposefully home-like, Tudor-revival setting. Using architectural historian Bernard Herman's concept of embedded landscapes, we show how the two hospitals differed in terms of their relationship to site, access, and, most importantly, to city, knowledge, and community. Architects Scopes & Feustmann, who designed the Laurentian hospital, operated an office at Saranac Lake, New York, America's premier destination for consumptives. The qualifications of Mount Sinai architects Spence & Goodman, however, derived from their experience with Jewish institutions in Montreal. Following Herman's approach to architecture through movement and context, how did notions of medical therapy and Judaism intersect in the plans of Mount Sinai?
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Geller, Stephen A. "Surgical pathology in the 20th century at The Mount Sinai Hospital, New York." Seminars in Diagnostic Pathology 25, no. 3 (August 2008): 178–89. http://dx.doi.org/10.1053/j.semdp.2008.06.003.
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Silverman, Lewis R., James F. Holland, Erin P. Demakos, Anna Gattani, and Janet Cuttner. "5-Azacytidine in myelodysplastic syndromes (MDS): The experience at mount Sinai Hospital, New York." Leukemia Research 18 (January 1994): 21. http://dx.doi.org/10.1016/0145-2126(94)90171-6.
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Holcombe, Randall F., Michelle Evangelista, and Frances Cartwright. "Delivery of Quality Oncology Care in a Large, Urban Practice: A Primer." Journal of Oncology Practice 12, no. 10 (October 2016): 892–97. http://dx.doi.org/10.1200/jop.2016.015040.
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A comprehensive quality improvement program is critically important for participation in value-based reimbursement models. Seven essential characteristics must be addressed in the development of a cancer-focused quality program. These include leadership, environment, engagement, ethos, metrics, accountability, and sustainability (Q=LE3MAS). This article describes how to address each essential characteristic and provides examples from the experience at Mount Sinai Hospital, a large, urban, academic hospital/health system in New York City.
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Ornstein, Katherine, Cameron R. Hernandez, Linda V. DeCherrie, and Theresa A. Soriano. "The Mount Sinai (New York) Visiting Doctors Program: Meeting the Needs of the Urban Homebound Population." Care Management Journals 12, no. 4 (December 2011): 139–43. http://dx.doi.org/10.1891/1521-0987.12.4.159.
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The Mount Sinai Visiting Doctors program, a joint program of Mount Sinai Medical Center’s Departments of Medicine and Geriatrics, is a large multidisciplinary teaching, research, and clinical care initiative serving homebound adults in Manhattan since 1995. Caring for more than 1,000 patients annually, the physicians of Visiting Doctors make more than 6,000 urgent and routine visits each year, making it the largest program of its kind in the country. Services include 24–hour physician availability, palliative care, social work case management, collaboration with nursing agencies, and in-home specialty consultation. The program serves many individuals who have previously received inadequate and inconsistent medical care. Patients are referred by social service agencies, local physicians, and hospitals and are primarily frail older individuals with complex needs. Funded by Mount Sinai and private support, the program serves as a major teaching site for medical, nursing, and social work trainees interested in home-based primary care.
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Trivedi, Vrinda, Raymonde E. Jean, Frank Genese, Katherine A. Fuhrmann, Anjeet K. Saini, Van Derick Mangulabnan, and Chirag Bavishi. "Impact of Obesity on Outcomes in a Multiethnic Cohort of Medical Intensive Care Unit Patients." Journal of Intensive Care Medicine 33, no. 2 (May 2, 2016): 97–103. http://dx.doi.org/10.1177/0885066616646099.
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Purpose: To examine the association of obesity with in-hospital mortality and complications during critical illness. Methods: We performed a retrospective analysis of a multiethnic cohort of 699 patients admitted to medical intensive care unit between January 2010 and May 2011 at Mount Sinai St. Luke’s and Mount Sinai West Hospitals, tertiary care centers in New York City. Multivariate logistic regression analysis was used to evaluate the association between obesity (body mass index [BMI] ≥ 30] and in-hospital mortality. Subgroup analysis was performed in elderly patients (age ≥65 years). Results: Compared to normal BMI, obese patients had lower in-hospital mortality (24.4% vs 17.6%, P = .04). On multivariate analysis, obesity was independently associated with lower in-hospital mortality (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.27-0.89, P = .018). There was no significant difference in rates of mechanical ventilation, reintubation, and vasopressor requirement across BMI categories. In subgroup analysis, elderly obese patients did not display lower in-hospital mortality (adjusted OR: 0.85, 95% CI: 0.40-1.82, P = .68). Conclusion: Our study supports the hypothesis that obesity is associated with decreased mortality during critical illness. However, this finding was not observed among elderly obese patients. Further studies should explore the interaction between age, obesity, and outcomes in critical illness.
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Paranjpe, Ishan, Adam J. Russak, Jessica K. De Freitas, Anuradha Lala, Riccardo Miotto, Akhil Vaid, Kipp W. Johnson, et al. "Retrospective cohort study of clinical characteristics of 2199 hospitalised patients with COVID-19 in New York City." BMJ Open 10, no. 11 (November 2020): e040736. http://dx.doi.org/10.1136/bmjopen-2020-040736.
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ObjectiveThe COVID-19 pandemic is a global public health crisis, with over 33 million cases and 999 000 deaths worldwide. Data are needed regarding the clinical course of hospitalised patients, particularly in the USA. We aimed to compare clinical characteristic of patients with COVID-19 who had in-hospital mortality with those who were discharged alive.DesignDemographic, clinical and outcomes data for patients admitted to five Mount Sinai Health System hospitals with confirmed COVID-19 between 27 February and 2 April 2020 were identified through institutional electronic health records. We performed a retrospective comparative analysis of patients who had in-hospital mortality or were discharged alive.SettingAll patients were admitted to the Mount Sinai Health System, a large quaternary care urban hospital system.ParticipantsParticipants over the age of 18 years were included.Primary outcomesWe investigated in-hospital mortality during the study period.ResultsA total of 2199 patients with COVID-19 were hospitalised during the study period. As of 2 April, 1121 (51%) patients remained hospitalised, and 1078 (49%) completed their hospital course. Of the latter, the overall mortality was 29%, and 36% required intensive care. The median age was 65 years overall and 75 years in those who died. Pre-existing conditions were present in 65% of those who died and 46% of those discharged. In those who died, the admission median lymphocyte percentage was 11.7%, D-dimer was 2.4 μg/mL, C reactive protein was 162 mg/L and procalcitonin was 0.44 ng/mL. In those discharged, the admission median lymphocyte percentage was 16.6%, D-dimer was 0.93 μg/mL, C reactive protein was 79 mg/L and procalcitonin was 0.09 ng/mL.ConclusionsIn our cohort of hospitalised patients, requirement of intensive care and mortality were high. Patients who died typically had more pre-existing conditions and greater perturbations in inflammatory markers as compared with those who were discharged.
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Wang, Jennifer, Evan Leibner, Jaime B. Hyman, Sanam Ahmed, Joshua Hamburger, Jean Hsieh, Neha Dangayach, et al. "The Mount Sinai Hospital Institute for critical care medicine response to the COVID-19 pandemic." Acute and Critical Care 36, no. 3 (August 31, 2021): 201–7. http://dx.doi.org/10.4266/acc.2021.00402.
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Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of critically ill patients. This was especially true in New York City. We present a roadmap for hospitals and healthcare systems to prepare for a Pandemic.Methods: This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the pandemic. MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds, expanded the workforce, and created guidelines.Results: MSH a 1,139-bed quaternary care academic referral hospital with 104 ICU beds expanded to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 42.8% (n=263) died, and 47.8% (n=294) were discharged alive.Conclusions: Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines were critical accommodating the surge of critically ill patients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives.
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Robb, Betty. "Psychosomatic Medicine and Contemporary Psychoanalysis: Graeme J Taylor, IUP Press." Ata: Journal of Psychotherapy Aotearoa New Zealand 1 (June 30, 1995): 106–7. http://dx.doi.org/10.9791/ajpanz.1995.12.
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Dr Graeme Taylor is a New Zealander who, subsequent to his MBChB from Otago, trained in psychiatry and psychosomatic medicine at the University of Toronto and State University of New York Medical Centre. Presently he is Associate Professor of Psychiatry at Toronto and consultant to Mount Sinai Hospital, and in this important and scholarly book Psychosomatic Medicine and Contemporary Psychoanalysis has bought together psychobiological research and psychoanalytic theory with child development observations in a much-needed synthesis from which he proposes a new model for understanding psychosomatic process based on pre-neurotic pathology as a consequence of faulty object relationships in early life.
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Nylin, Gustav. "Sidney A. Gladstone: Cardiac output and arterial hypertension. Report from the Mount Sinai Hospital, New York City, 1935." Acta Medica Scandinavica 89, no. 1-2 (April 24, 2009): 229. http://dx.doi.org/10.1111/j.0954-6820.1936.tb15427.x.
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Abraham, Albin, Kaleem Rizvon, Jaspreet Singh, Ghulam Siddiqui, Apsara Prasad, Sadat Rashid, Magdalene Vardaros, Vikas Garg, Krishnaiyer Subramani, and Paul Mustacchia. "Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent." Case Reports in Gastrointestinal Medicine 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/205979.
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Laparoscopic sleeve gastrectomy has been a recently developed technique for treating morbid obesity. Gagner and Patterson performed the first laparoscopic sleeve gastrectomy as part of a duodenal switch procedure at Mount Sinai Hospital in New York in 1999. Since then many surgeons and institutions have adopted this technique. One of the most dreaded complications of sleeve gastrectomy is a leak along the staple line. We present the case of a 23-year-old female with gastric sleeve leak managed successfully with a fully covered wall flex stent. Our aim is to examine the incidence, causes, classification, and presentation of gastric sleeve leaks and to evaluate the use of endoscopic stents in its management.
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Wang, Zichen, Amanda Zheutlin, Yu-Han Kao, Kristin Ayers, Susan Gross, Patricia Kovatch, Sharon Nirenberg, et al. "Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records." BMJ Open 10, no. 10 (October 2020): e040441. http://dx.doi.org/10.1136/bmjopen-2020-040441.
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ObjectiveTo assess association of clinical features on COVID-19 patient outcomes.DesignRetrospective observational study using electronic medical record data.SettingFive member hospitals from the Mount Sinai Health System in New York City (NYC).Participants28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases.Main outcomes and measuresPositive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities.ResultsHispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray’s T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation.ConclusionsWhile race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.
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Remotti, Helen, Sukanya Subramanian, Mercedes Martinez, Tomoaki Kato, and Margret S. Magid. "Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations." Archives of Pathology & Laboratory Medicine 136, no. 7 (July 1, 2012): 761–71. http://dx.doi.org/10.5858/arpa.2011-0596-ra.
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Context.—Intestinal transplant has become a standard treatment option in the management of patients with irreversible intestinal failure. The histologic evaluation of small-bowel allograft biopsy specimens plays a central role in assessing the integrity of the graft. It is essential for the management of acute cellular and chronic rejection; detection of infections, particularly with respect to specific viruses (cytomegalovirus, adenovirus, Epstein-Barr virus); and immunosuppression-related lymphoproliferative disease. Objective.—To provide a comprehensive review of the literature and illustrate key histologic findings in small-bowel biopsy specimen evaluation of patients with small-bowel or multivisceral transplants. Data Sources.—Literature review using PubMed (US National Library of Medicine) and data obtained from national and international transplant registries in addition to case material at Columbia University, Presbyterian Hospital, and Mount Sinai Medical Center, New York, New York. Conclusions.—Key to the success of small-bowel transplantation and multivisceral transplantation are the close monitoring and appropriate clinical management of patients in the posttransplant period, requiring coordinated input from all members of the transplant team with the integration of clinical, laboratory, and histopathologic parameters.
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Kastor, John A. "Failure of the Merger of the Mount Sinai and New York University Hospitals and Medical Schools: Part 1." Academic Medicine 85, no. 12 (December 2010): 1823–27. http://dx.doi.org/10.1097/acm.0b013e3181f65000.
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Kastor, John A. "Failure of the Merger of the Mount Sinai and New York University Hospitals and Medical Schools: Part 2." Academic Medicine 85, no. 12 (December 2010): 1828–32. http://dx.doi.org/10.1097/acm.0b013e3181f65019.
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Mazo, Dana, Lindsey Gottlieb, Sarah Schaefer, Kinta Alexander, Jordan Ehni, Waleed Javaid, Gopi Patel, Judith Aberg, and Scott Lorin. "LB13. Candida auris in NYC: A Health System’s Experience Treating the Emerging Drug-Resistant Yeast." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S764. http://dx.doi.org/10.1093/ofid/ofy229.2187.
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Abstract Background Candida auris is emerging multidrug-resistant yeast that can cause serious infections with published mortality rates as high as 60%. It was first recognized in 2009 and has been reported in over a dozen countries. The current United States outbreak was identified in 2016 with New York City (NYC) as the epicenter. The aim of this evaluation was to describe the clinical infections and outcomes with C. auris in a large health system in NYC. Methods Cases were identified from clinical specimens collected December 2015–June 2018 from the Mount Sinai Hospital Clinical Microbiology Laboratory, the central laboratory for the Mount Sinai Health System, which encompasses seven hospitals across NYC. All C. auris isolates were confirmed by the New York State Department of Health Wadsworth Center. Medical charts were reviewed. A case was included if C. auris grew from a sterile body site, an antifungal treatment was initiated or the patient expired before the yeast was identified on Gram stain. Results Twenty-nine possible cases were identified with 23 meeting the case definition. These cases included 19 bloodstream infections (BSI), two intra-abdominal abscesses, one skin soft tissue infection, and one otitis externa. Using the MIC breakpoints recommended by the Centers for Disease Control and Prevention, 100% of isolates tested were susceptible to caspofungin, 29% were susceptible to amphotericin B, and 17% were susceptible to fluconazole. Nineteen patients received antifungal treatment, 13 with caspofungin monotherapy and four with sequential therapy of caspofungin followed by an azole (three with fluconazole, one with posaconazole). Fifteen (65%) patients expired within 90 days of the positive culture. Fourteen of the deaths were in candidemic patients, despite that eight (57%) of these patients had documented microbiologic clearance after appropriate therapy. The 90-day mortality rate was 74% for BSI. Conclusions This case series is the largest reported in the United States. Candidemia was the most common site of infection and had a very high 90-day mortality rate, despite sterilization of the blood. These findings highlight the significant morbidity and mortality associated with C. auris and the need to focus efforts on rapid diagnostics and infection prevention. Disclosures All authors: No reported disclosures.
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Segal, Robert Lloyd, and Sylvan Wallenstein. "THE OCCURRENCE OF GRAVES DISEASE (AUTOIMMUNE THYROTOXICOSIS) IN ENDOCRINOLOGISTS AT THE MOUNT SINAI HOSPITAL IN NEW YORK CITY FROM 1954 TO 2011." Endocrine Practice 21, no. 5 (May 2015): 482–87. http://dx.doi.org/10.4158/ep14342.or.
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McCulloch, Jock, and Geoffrey Tweedale. "Shooting the Messenger: The Vilification of Irving J. Selikoff." International Journal of Health Services 37, no. 4 (October 2007): 619–34. http://dx.doi.org/10.2190/hs.37.4.b.
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Dr. Irving J. Selikoff (1915–1992), a New York physician based at Mount Sinai Hospital, was the leading American medical expert on asbestos-related diseases between the 1960s and early 1990s. In a country that had been the world's greatest consumer of asbestos, he was also at the center of the key controversies connected with the mineral. In these controversies, Selikoff was consistently demonized as a media zealot who exaggerated the risks of asbestos on the back of bogus medical qualifications and flawed science. Since his death, the criticism has become even more vituperative and claims have persisted that he was malicious or a medical fraud. However, most of the attacks on Selikoff were inspired by the asbestos industry or its sympathizers, and for much of his career he was the victim of a sustained and orchestrated campaign to discredit him. The most serious criticisms usually more accurately describe his detractors than Selikoff himself.
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Riollano, Mariawy, Christina L. Marshall, shanna kowalsky, Michael Tosi, Roberto Posada, Rebecca Trachtman, Alberto Paniz-Mondolfi, and Emilia Sordillo. "401. Short Term Outcomes in Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S268—S269. http://dx.doi.org/10.1093/ofid/ofaa439.596.
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Abstract Background MIS-C is a multi-system inflammatory syndrome which has been described in pediatric patients after COVID-19 since late April. Our objective is to describe the short-term outcomes of the first 15 cases with MIS-C, who presented for care to a tertiary pediatric referral center. Methods This is a retrospective chart review of patients who met MIS-C criteria based on the New York State Department of Health case definition and who were admitted to the Mount Sinai Hospital in New York City, between April 24 and May 14, 2020. We collected clinical and laboratory data during their hospital admission and subsequent outpatient follow up. Results The range of the length of hospital stay was 6–13 days (mean=7 days). One patient expired on day 9 of hospitalization. At the time of discharge, all patients had normalization of inflammatory markers. All patients were discharged on anticoagulation therapy for 14 days. One patient was readmitted with a subdural hematoma at day 13 post discharge and 3 patients had bruising at their follow up visit 7–12 days after hospital discharge. All patients had normalization of cardiac enzymes prior to hospital discharge. Abnormalities in coronary arteries and cardiac function which were observed during hospitalizations in 4 (27%) and 8 (53%) patients respectively, had resolved by day 6–35 post discharge (mean=20 days). Conclusion Although patients with MIS-C can present with severe multi-organ involvement and shock, the majority of the patients in our experience had resolution of symptoms and normalization of laboratory parameters within a few weeks of initial symptoms. Our findings underscore the need to carefully weigh the risk and benefits of anticoagulation therapy and to monitor this treatment closely. Further research is needed to determine long-term outcomes of these patients. Disclosures All Authors: No reported disclosures
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P Brockway, Julia, Keerti Murari, Alexandra Rosenberg, Orit Saigh, Matthew J. Press, and Jenny J. Lin. "Differences in primary care providers’ and oncologists’ views on communication and coordination of care during active treatment of patients with cancer and comorbidities." International Journal of Care Coordination 22, no. 2 (June 2019): 51–57. http://dx.doi.org/10.1177/2053434519857582.
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Introduction Management of comorbid diseases in patients with cancer is often unclear. The purpose of our study was to identify differences and similarities between primary care providers and oncologists’ knowledge, attitudes, and beliefs regarding coordination of care and comorbid disease management for patients undergoing active cancer treatment. Methods We conducted a cross-sectional study using an anonymous self-administered survey which was available to approximately 600 providers in primary care and medical oncology practicing in both outpatient and inpatient settings from March to December 2014 at three academic hospitals in New York City (Mount Sinai Hospital, Mount Sinai Beth Israel, and Weill Cornell). Our survey instrument assessed physician knowledge, attitudes, and beliefs using a clinical vignette of a cancer patient undergoing active treatment. Descriptive statistics were used to summarize the demographic and practice details of survey responses, and univariate analyses were used to assess differences in responses between primary care providers and oncologists. Results The survey was completed by 203 providers, including 127 primary care providers (62.5%), 32 medical oncologists (15.8%), 11 palliative care physicians (5.4%), and 33 nurse practitioners or physician assistants (16.3%). Medical oncologists admitted more uncertainty regarding who should manage preventive care as compared to primary care providers (34.4% vs. 16.5%, p = 0.02), whereas primary care providers were more concerned about duplicated care (22.8% vs. 6.3%, p = 0.03). Both primary care providers and medical oncologists agreed that diabetes should be actively managed during cancer treatment. More primary care providers felt less strict glycemic control was allowable (56.8% vs. 37.5%, p = 0.05) and that it is allowable for patients to miss some diabetes-related visits (80.6% vs. 56.3%, p = 0.01). Discussion Primary care providers and medical oncologists differ in their knowledge, attitudes, and beliefs regarding coordination of care and management of comorbid conditions in patients undergoing cancer treatment. These differences reflect systemic challenges to provision of care to cancer patients and the need for a model of care coordination.
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Berkowitz, Gertrud S., Robert H. Lapinski, Jacqueline G. Gazella, Stephen E. Dolgin, Carol A. Bodian, and Ian R. Holzman. "Prevalence and Natural History of Cryptorchidism." Pediatrics 92, no. 1 (July 1, 1993): 44–49. http://dx.doi.org/10.1542/peds.92.1.44.
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Objective. A prospective hospital-based cohort study was conducted to determine the prevalence rates of cryptorchidism at birth, 3 months, and 1 year of age. Design. A total of 6935 consecutive male neonates delivered at Mount Sinai Hospital in New York City between October 1987 and October 1990 were examined at birth for cryptorchidism. Standardized examination and classification criteria were used. Infants classified as cryptorchid at birth were reexamined at 3 months and 1 year after the expected date of delivery. Results. Of 6935 neonates assessed at birth, 255(3.7%) were found to be cryptorchid at birth. The rates were significantly elevated for low birth weight, preterm, small-for-gestational age, and twin neonates. The overall rate had declined to 1.0% by the 3-month assessment and 1.1% at the 1-year assessment. Although the rates at the 1-year assessment tended to be higher for low birth weight and preterm infants, no significant group differences were observed. Conclusions. Since the prevalence rates in this study are similar to those reported several decades ago, these data provide no evidence that the rate of cryptorchidism has increased either at birth or by 1 year of age. Furthermore, most testes that descend spontaneously do so within the first 3 months after the expected date of delivery.
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Salib, Christian, Pallavi Khattar, Jinjun Cheng, and Julie Teruya-Feldstein. "Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City." Blood 136, Supplement 1 (November 5, 2020): 26–27. http://dx.doi.org/10.1182/blood-2020-142581.
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INTRODUCTION Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent studies have suggested that COVID-19 positive patients present with leukopenia, lymphopenia, neutrophilia, thrombocytopenia, and higher neutrophil: lymphocyte ratio (NLR) and monocyte: lymphocyte ratio (MLR). More recently, we reported hypersegmented granulocytes and COVID-19 infection in Blood. 2020 Jun 11;135(24):2196. Neutrophil hypersegmentation has been closely associated with vitamin B12, folate and iron deficiencies, as well as methotrexate use, chemotherapy toxicity, uremia, heat stroke, myelodysplasia and Boucher-Neuhäuser Syndrome. Initially, these cytomorphologic changes may easily be overlooked or dismissed as non-specific reactive changes. In this study, we expand our initial observation on our index case to a larger case series. To the best of our knowledge, this is the largest case series to describe the concurrent lymphocyte and unique granulocyte atypia associated with SARS-CoV-2 infection. METHODS Study Design 2,199 patients were hospitalized in the Mount Sinai Health System from Feb 27 to April 2, 2020 with confirmed COVID-19 positivity. Data obtained for this study was covered under an Institutional Review Board (IRB) waiver, HS#:12-00133 GCO#1:12-036(0001-08) Inclusion criteria 50 peripheral blood smears flagged for Pathologist review from March 13 - April 20, 2020 at Mount Sinai Hospital Clinical Hematology Laboratory were included in this study. All suspected COVID-19 cases were confirmed using real-time polymerase chain reaction (RT-PCR) assay to test nasal and pharyngeal swab specimens, per WHO guidelines. Of the 50 COVID-19 positive peripheral blood smears, 39 slides were scanned and imaged with Scopio Labs X100 Full Field Digital Microscope. The X100 provided high resolution oil-immersion level images of large scanned areas. https://scopiolabs.com/hematology/ 19 peripheral blood smears were blindly and independently reviewed by 4 Hematopathologists (CS, PK, JC, JTF), with particular emphasis on granulocyte cytomorphology and percent of hypersegmented neutrophils present (defined as neutrophils with 5 or more nuclear lobes in at least 3% of cells or presence of 6 or more lobes). Atypical lymphocyte morphology was also evaluated and categorized as Downey type I, II, III or plasmacytoid, while monocyte morphology was assessed for unusual nuclear folds and features. Evaluation of platelets and other abnormalities were noted. The presence and degree of significant cytologic atypia was recorded and compared to 20 COVID-19 negative blood smears. RESULTS 16 of the 19 (84%) COVID-19 positive cases showed hypersegmented neutrophils, and all 19 harbored atypical lymphocytes and monocyte morphology, with giant platelets. In contrast, 5 of the 20 (25%) COVID-19 negative cases showed hypersegmented neutrophils, with 2 patients displaying atypical monocytes; none showed atypical lymphocytes or giant platelets (p = 0.022). Concurrent laboratory values showed no evidence of vitamin B12 or folate deficiency. Representative images are summarized in Figure 1 (A-C, 5-6 lobed neutrophils; D-E atypical plasmacytoid lymphocytes, G-I atypical monocytes, J-L giant platelets). CONCLUSION We report atypical hypersegmented neutrophils with toxic cytoplasmic change, atypical monocytes, plasmacytoid lymphocytes, and giant platelets in peripheral blood smears of COVID-19 patients which are significantly higher than in control COVID-19 negative patients. Figure 1 Disclosures Teruya-Feldstein: Edge Anthem: Consultancy.
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Jácome Roca, Alfredo. "Académico honorario Egon Lichtemberger Salomón y académico correspondiente extranjero Roger Guerra-García." Medicina 42, no. 3 (October 3, 2020): 501–2. http://dx.doi.org/10.56050/01205498.1546.
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El Académico Egon Lichtenberger falleció en Bogotá en mayo de 2020, a sus 99 años. Ante la situación de la comunidad judía durante el gobierno del Tercer Reich, en 1936 su familia emigró a Bogotá, pensando en que con Hitler, ningún lugar de Europa era seguro. El joven Egon quedó marcado por aquel inhumano “holocausto judío” que lo volvió escéptico de la rectoría del universo, aunque su vida fue un testimonio de la posibilidad de un mundo mejor. Fue un gran admirador de Churchill, por la entereza que mostró para enfrentar sin reparos al líder nazi, sin quitar la vista del soviético. Tal vez era el sentimiento de la época, también experimenté lo mismo, aunque dos décadas después. Estudió medicina en la Universidad Nacional de Colombia e inició su formación de patología al lado de Juan Pablo Llinás (formado en París) y Manuel Sánchez Herrera, quien estuvo en Harvard. Posteriormente hizo posgrados en Durham University de New Castle Upon Tyne, en Inglaterra y el Mount Sinai Hospital, Columbia University, de Nueva York. En 1952 regresó a Colombia y se vinculó al Hospital San Juan de Dios de Bogotá, donde, aprovechando el alto número de autopsias practicadas (de fallecidos de la Hortúa, el Instituto Nacional d Cancerología, y el Instituto Materno Infantil), inició actividades docente asistenciales con microscopía diagnóstica y con reuniones clínicopatológicas que pronto se tornaron en el centro de la docencia en ese hospital, regentado por la Universidad Nacional. Por años fue jefe del departamento de Patología, y con él trabajó un grupo de renombrados patólogos, y se entrenaron muchos residentes.
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El académico correspondiente extranjero Roger Guerra-García (1933-2020) falleció a los 87 años en Lima, según información enviada por la Academia Nacional de Medicina del Perú, de la cual fue presidente. También ocupó este máximo cargo en la Academia Nacional de Ciencias del país andino. Guerra-García fue egresado de la Universidad Mayor de San Marcos e hizo estudios de postgrado en Endocrinología y Bioquímica en el Hospital Monte Sinai de Nueva York y en la Universidad de Boston. Fue por muchos años profesor universitario y en diversos períodos presidente de la Sociedad Peruana de Endocrinología, fue el primer presidente del Consejo Nacional de Ciencia y Tecnología CONCYTEC -entidad similar a ColcienciasVice-Ministro de Educación, Rector de la Universidad Peruana Cayetano Heredia y Senador de la República. Participó en los congresos bolivarianos de endocrinología como conferencista.
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Feingold, Jordyn H., Lauren Peccoralo, Chi C. Chan, Carly A. Kaplan, Halley Kaye-Kauderer, Dennis Charney, Jaclyn Verity, et al. "Psychological Impact of the COVID-19 Pandemic on Frontline Health Care Workers During the Pandemic Surge in New York City." Chronic Stress 5 (January 2021): 247054702097789. http://dx.doi.org/10.1177/2470547020977891.
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Background This study sought to assess the magnitude of and factors associated with mental health outcomes among frontline health care workers (FHCWs) providing care during the Spring 2020 COVID-19 pandemic surge in New York City. Methods A cross-sectional, survey-based study over 4 weeks during the Spring 2020 pandemic surge was used to assess symptoms of COVID-19-related posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in 2,579 FHCWs at the Mount Sinai Hospital. Participants were additionally asked about their occupational and personal exposures to COVID-19. Multivariable logistic regression and relative importance analyses were conducted to identify factors associated with these outcomes. Results A total of 3,360 of 6,026 individuals completed the survey (55.8% participation), with 2,579 (76.8%) analyzed based on endorsing frontline responsibilities and providing information related to the three outcomes. 1,005 (39.0%) met criteria for symptoms of COVID-19-related PTSD, MDD, or GAD. 599 (23.3%) screened positively for PTSD symptoms, 683 (26.6%) for MDD symptoms, and 642 (25.0%) for GAD symptoms. Multivariable analyses revealed that past-year burnout was associated with the highest risk of developing symptoms for COVID-19-related PTSD (odds ratio [OR] = 2.10), MDD (OR = 2.83), and GAD (OR = 2.68). Higher perceived support from hospital leadership was associated with a lowest risk of all outcomes [PTSD (OR = 0.75), MDD (OR = 0.72), and GAD (OR = 0.76). Conclusion In this large sample of FHCWs providing care during the 2020 NYC pandemic surge, 39% experienced symptoms of COVID-19-related PTSD, MDD, and/or GAD and pre-pandemic burnout as well as leadership support were identified as the most highly associated factors. These findings suggest that interventions aimed at reducing burnout and augmenting support from hospital leadership may be appropriate targets to mitigate the risk for developing further psychopathology in this population and others working in the midst of crisis.
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Menon, Vidya, Masood A. Shariff, Victor Perez Gutierrez, Juan M. Carreño, Bo Yu, Muzamil Jawed, Marcia Gossai, et al. "Longitudinal humoral antibody response to SARS-CoV-2 infection among healthcare workers in a New York City hospital." BMJ Open 11, no. 10 (October 2021): e051045. http://dx.doi.org/10.1136/bmjopen-2021-051045.
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ObjectiveDynamics of humoral immune responses to SARS-CoV-2 antigens following infection suggest an initial decay of antibody followed by subsequent stabilisation. We aim to understand the longitudinal humoral responses to SARS-CoV-2 nucleocapsid (N) protein and spike (S) protein and to evaluate their correlation to clinical symptoms among healthcare workers (HCWs).DesignA prospective longitudinal study.SettingThis study was conducted in a New York City public hospital in the South Bronx, New York.ParticipantsHCWs participated in phase 1 (N=500) and were followed up 4 months later in phase 2 (N=178) of the study. They underwent SARS-CoV-2 PCR and serology testing for N and S protein antibodies, in addition to completion of an online survey in both phases. Analysis was performed on the 178 participants who participated in both phases of the study.Primary outcome measureEvaluate longitudinal humoral responses to viral N (qualitative serology testing) and S protein (quantitative Mount Sinai Health System ELISA to detect receptor-binding domain and full-length S reactive antibodies) by measuring rate of decay.ResultsAnti-N antibody positivity was 27% and anti-S positivity was 28% in phase 1. In phase 1, anti-S titres were higher in symptomatic (6754 (5177–8812)) than in asymptomatic positive subjects (5803 (2825–11 920)). Marginally higher titres (2382 (1494–3797)) were seen in asymptomatic compared with the symptomatic positive subgroup (2198 (1753–2755)) in phase 2. A positive correlation was noted between age (R=0.269, p<0.01), number (R=0.310, p<0.01) and duration of symptoms (R=0.434, p<0.01), and phase 1 anti-S antibody titre. A strong correlation (R=0.898, p<0.001) was observed between phase 1 titres and decay of anti-S antibody titres between the two phases. Significant correlation with rate of decay was also noted with fever (R=0.428, p<0.001), gastrointestinal symptoms (R=0.340, p<0.05), and total number (R=0.357, p<0.01) and duration of COVID-19 symptoms (R=0.469, p<0.001).ConclusionsHigher initial anti-S antibody titres were associated with larger number and longer duration of symptoms as well as a faster decay between the two time points.
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Rees, J. R. E., and P. Burgess. "An Abdominal Presentation of Churg-Strauss Syndrome." Case Reports in Medicine 2010 (2010): 1–4. http://dx.doi.org/10.1155/2010/290654.
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Churg-Strauss syndrome is a small and medium vessel vasculitis that is also known as allergic granulomatous angiitis. It most commonly presents with an asthma like symptoms. It was first described in Mount Siani Hospital, New York in 1951 by Jacob Churg and Lotte Stauss and was recognised after the study of a series of 13 patients who had asthma, eosinophilia, granulomatous inflammation necrotising systemic vasculitis and necrotising glomerulonephritis. We describe a case of Churg-Strauss syndrome presenting with abdominal pain and later during the hospital admission a mono-neuritis multiplex syndrome affecting the lower limbs. The patient presented in such an atypical fashion with abdominal signs and symptoms that they required laparotomy and the diagnosis was made after histological examination of tissue taken at the time of surgery. Treatment with immunosuppression and aggressive rehabilitation achieved a progressive recovery which continued on discharge from hospital.
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Van Hootegem, Philippe, and Simon Travis. "Is Crohn’s Disease a Rightly Used Eponym?" Journal of Crohn's and Colitis 14, no. 6 (November 8, 2019): 867–71. http://dx.doi.org/10.1093/ecco-jcc/jjz183.
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Abstract In 1932 Burrill B. Crohn, a gastroenterologist at Mount Sinai Hospital in New York City, described, together with two surgical colleagues, a series of 14 patients with an inflammatory condition of the terminal ileum. All patients were operated on by Dr Albert Berg, the Chief Surgeon of the hospital, whose name did not appear on the initial publication. The ‘new’ disease was called ‘regional ileitis’, but was rapidly referred to as ‘Crohn’s disease’. From earlier accounts and publications it has become clear that the condition had already existed for many centuries and was ‘discovered’ several times before 1932, most notably by Giovanni Morgagni in 1769, Antoni Lesniowski in 1903 and Thomas K. Dalziel in 1913. ‘Crohn’s disease’ might reasonably be known by another eponym. Nevertheless, the 1932 publication of Crohn was pivotal, as were his later contributions to the knowledge of ‘his’ disease. Therefore the worldwide use of the eponym is rightly to be continued. Present researchers and clinicians with an interest in inflammatory bowel disease [IBD] might learn from the complicated story summarised in this contribution. Apart from an interesting historical overview, there are some lessons for today: the importance of thorough clinical observation and pattern recognition, the need for communication between colleagues and multidisciplinary approaches, and the need for broad access to valuable data, past or present, regardless of the journal or language of publication. It should ultimately bring us some humility, despite great achievements in treating this chronic disease, which defies all our efforts yet to find a cure.
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Fani, Shamsi, Lizette Munoz, Susana Lavayen, Blair McKenzie, Audrey Chun, Jeff Cao, and Stephanie Chow. "Decreasing Emergency Room Utilization in High Risk Geriatric Patients." Innovation in Aging 4, Supplement_1 (December 1, 2020): 135. http://dx.doi.org/10.1093/geroni/igaa057.443.
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Abstract Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.
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Vaid, Akhil, Sulaiman Somani, Adam J. Russak, Jessica K. De Freitas, Fayzan F. Chaudhry, Ishan Paranjpe, Kipp W. Johnson, et al. "Machine Learning to Predict Mortality and Critical Events in a Cohort of Patients With COVID-19 in New York City: Model Development and Validation." Journal of Medical Internet Research 22, no. 11 (November 6, 2020): e24018. http://dx.doi.org/10.2196/24018.
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Background COVID-19 has infected millions of people worldwide and is responsible for several hundred thousand fatalities. The COVID-19 pandemic has necessitated thoughtful resource allocation and early identification of high-risk patients. However, effective methods to meet these needs are lacking. Objective The aims of this study were to analyze the electronic health records (EHRs) of patients who tested positive for COVID-19 and were admitted to hospitals in the Mount Sinai Health System in New York City; to develop machine learning models for making predictions about the hospital course of the patients over clinically meaningful time horizons based on patient characteristics at admission; and to assess the performance of these models at multiple hospitals and time points. Methods We used Extreme Gradient Boosting (XGBoost) and baseline comparator models to predict in-hospital mortality and critical events at time windows of 3, 5, 7, and 10 days from admission. Our study population included harmonized EHR data from five hospitals in New York City for 4098 COVID-19–positive patients admitted from March 15 to May 22, 2020. The models were first trained on patients from a single hospital (n=1514) before or on May 1, externally validated on patients from four other hospitals (n=2201) before or on May 1, and prospectively validated on all patients after May 1 (n=383). Finally, we established model interpretability to identify and rank variables that drive model predictions. Results Upon cross-validation, the XGBoost classifier outperformed baseline models, with an area under the receiver operating characteristic curve (AUC-ROC) for mortality of 0.89 at 3 days, 0.85 at 5 and 7 days, and 0.84 at 10 days. XGBoost also performed well for critical event prediction, with an AUC-ROC of 0.80 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. In external validation, XGBoost achieved an AUC-ROC of 0.88 at 3 days, 0.86 at 5 days, 0.86 at 7 days, and 0.84 at 10 days for mortality prediction. Similarly, the unimputed XGBoost model achieved an AUC-ROC of 0.78 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. Trends in performance on prospective validation sets were similar. At 7 days, acute kidney injury on admission, elevated LDH, tachypnea, and hyperglycemia were the strongest drivers of critical event prediction, while higher age, anion gap, and C-reactive protein were the strongest drivers of mortality prediction. Conclusions We externally and prospectively trained and validated machine learning models for mortality and critical events for patients with COVID-19 at different time horizons. These models identified at-risk patients and uncovered underlying relationships that predicted outcomes.
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Kummer, Benjamin R., Eyal Klang, Laura K. Stein, Mandip S. Dhamoon, and Nathalie Jetté. "History of Stroke Is Independently Associated With In-Hospital Death in Patients With COVID-19." Stroke 51, no. 10 (October 2020): 3112–14. http://dx.doi.org/10.1161/strokeaha.120.030685.
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Background and Purpose: In December 2019, an outbreak of severe acute respiratory syndrome coronavirus causing coronavirus disease 2019 (COVID-19) occurred in China, and evolved into a worldwide pandemic. It remains unclear whether the history of cerebrovascular disease is associated with in-hospital death in patients with COVID-19. Methods: We conducted a retrospective, multicenter cohort study at Mount Sinai Health System in New York City. Using our institutional data warehouse, we identified all adult patients who were admitted to the hospital between March 1, 2020 and May 1, 2020 and had a positive nasopharyngeal swab polymerase chain reaction test for severe acute respiratory syndrome coronavirus in the emergency department. Using our institutional electronic health record, we extracted clinical characteristics of the cohort, including age, sex, and comorbidities. Using multivariable logistic regression to control for medical comorbidities, we modeled the relationship between history of stroke and all-cause, in-hospital death. Results: We identified 3248 patients, of whom 387 (11.9%) had a history of stroke. Compared with patients without history of stroke, patients with a history of stroke were significantly older, and were significantly more likely to have a history of all medical comorbidities except for obesity, which was more prevalent in patients without a history of stroke. Compared with patients without history of stroke, patients with a history of stroke had higher in-hospital death rates during the study period (48.6% versus 31.7%, P <0.001). In the multivariable analysis, history of stroke (adjusted odds ratio, 1.28 [95% CI, 1.01–1.63]) was significantly associated with in-hospital death. Conclusions: We found that history of stroke was associated with in-hospital death among hospitalized patients with COVID-19. Further studies should confirm these results.
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Moss, Marie, Waleed Javaid, Jordan Ehni, Bernard Camins, and Barbara Barnett. "Achieving a Sustained Decrease in Facility-wide C. difficile Incidence in an Acute-Care Hospital in New York City." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s108—s110. http://dx.doi.org/10.1017/ice.2020.613.
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Background: Mount Sinai Beth Israel is a 350-bed, acute-care hospital located on Manhattan’s Lower East Side. In 2014, the hospital had reached a high (9.8 cases per 10,000 patient days ) hospital-onset (HO) C. difficile rate. By 2015, this rate had decreased to 5.6 cases per 10,000 patient days because of compliance with established C.difficile bundle practices performed by nursing and environmental services. Despite these interventions, HO C. difficile events continued to occur. We realized that more had to be done to gain control over our rates. To determine areas for further improvement, infection prevention held an RCA meeting for every positive hospital-onset result. We discovered from these RCAs that many C. difficile tests were ordered without a valid indication. We believed that measures could be taken to ensure that only C. difficile tests with a valid indication would be ordered. Methods: We used the Plan-Do-Study-Act (PDSA) model to look at what changes could be made to reduce our rate and to sustain this reduction. Multidisciplinary meetings of leaders and frontline staff were held to determine why patients were being tested for C. difficile. The following indications were revealed: repeat tests for same patient to “catch” a positive result after the first test was negative; inclusion as part of patient “pan-culturing”; testing patients who had diarrhea after receiving laxatives; and C. difficile cultures for patients who were asymptomatic. Starting in 2016, 3 consecutive interventions were implemented in fairly rapid succession. First, a C. difficile testing algorithm was developed. Second, a C. difficile test order protocol with a “hard stop” to prevent inappropriate indications was placed in the EMR. Last, a multidisciplinary form, called the C. difficile Team Huddle Form, was created for use by all members of the patient’s team. This form gave MDs, RNs, and PCAs a framework to decide together whether the test was indicated for the patient. If the team agreed to test, the ID physician on service was called for approval. Results: These 3 interventions yielded a sustained and statistically significant decrease (P = 0.0007) in the facility-wide hospital-onset C. difficile from a preintervention rate of 5.6 cases per 10,000 patient days in 2015 to 0.4 in 2019. Conclusions: Multidisciplinary use of the C. difficile testing interventions led to further reduction of the hospital-onset C. difficile infection rate. To sustain this rate reduction over time, infection prevention specialists must work with providers and frontline staff on an ongoing basis.Funding: NoneDisclosures: None
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Diefenbacher, A., U. Golombek, and J. J. Strain. "Personality Disorders in Consultation-liaison Psychiatry - an Empirical Investigation." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70571-1.
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Up to now hardly any quantitative research regarding diagnosis of personality disorders in the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine is available.The data of 3032 patients aged 17-65 years seen between 1988 and 1997 at the Mount Sinai Hospital in New York, NY, were recorded and analyzed using the Micro-Cares Database System.19,7% (N=598) of patients exhibited a personality disorder. Out of those 7,7% distributed to Cluster A (Odd or Eccentric Behavior), 54,3% to Cluster B and 38,0% to Cluster C.89% of patients with personality disorders showed at least one additional specific psychiatric disorder.Patients with a personality disorder had a lower incidence of somatic disease, but exhibited a higher level in psychosocial impairment and a higher comorbidity in substance abuse. During the previous year they used psychiatric treatment more often and were in need of a more intense social and psychotherapeutical treatment.The age group of 17-40 year old patients with a personality disorder was hospitalized shorter and had less of a lag between hospitalization and time of psychiatric consultation.More reasons for a psychiatric consultation were given when patients with a personality disorder were referred.In the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine every 5th to 6th patient requires a specific, psychiatric, psychotherapeutic or social treatment because of a personality disorder.The classification of personality disorders into clusters did not yield an additional benefit.
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Diefenbacher, A., U. Golombek, and J. J. Strain. "Personality Disorders in Consultation-liaison Psychiatry - an Empirical Investigation." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71305-7.
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Up to now hardly any quantitative research regarding diagnosis of personality disorders in the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine is available.The data of 3032 patients aged 17-65 years seen between 1988 and 1997 at the Mount Sinai Hospital in New York, NY, were recorded and analyzed using the Micro-Cares Database System.19,7% (N=598) of patients exhibited a personality disorder. Out of those 7,7% distributed to Cluster A (Odd or Eccentric Behavior), 54,3% to Cluster B and 38,0% to Cluster C.89% of patients with personality disorders showed at least one additional specific psychiatric disorder.Patients with a personality disorder had a lower incidence of somatic disease, but exhibited a higher level in psychosocial impairment and a higher comorbidity in substance abuse. During the previous year they used psychiatric treatment more often and were in need of a more intense social and psychotherapeutical treatment.The age group of 17-40 year old patients with a personality disorder was hospitalized shorter and had less of a lag between hospitalization and time of psychiatric consultation.More reasons for a psychiatric consultation were given when patients with a personality disorder were referred.In the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine every 5th to 6th patient requires a specific, psychiatric, psychotherapeutic or social treatment because of a personality disorder.The classification of personality disorders into clusters did not yield an additional benefit.
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Navale, Pooja, Ira J. Bleiweiss, Shabnam Jaffer, and Anupma Nayak. "Evaluation of Biomarkers in Multiple Ipsilateral Synchronous Invasive Breast Carcinomas." Archives of Pathology & Laboratory Medicine 143, no. 2 (September 7, 2018): 190–96. http://dx.doi.org/10.5858/arpa.2017-0494-oa.
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Context.— The College of American Pathologists guidelines recommend testing additional tumor foci in multifocal invasive breast carcinomas for the biomarkers estrogen receptor (ER), progesterone receptor, and HER2 only if the carcinomas show different morphologies or grades. Objective.— To assess clinical significance of testing for biomarkers in additional tumor foci in multifocal invasive breast tumors. Design.— Retrospective analysis of 118 patients diagnosed with ipsilateral synchronous multifocal breast carcinomas from January 2015 through March 2016 at Mount Sinai Hospital (New York, New York). Results.— Eighty-six cases were tested for at least 1 of the 3 biomarkers in additional tumor foci. Fifteen cases (17%) showed discordant staining between the 2 foci for at least one biomarker. Of the 7 of 67 ER-discordant cases (10%), 4 (57%) showed major variation from negative to positive expression, including 3 cases in which a smaller tumor focus was strongly positive for ER whereas the index tumor was negative. Similarly, within the 7 of 67 progesterone receptor–discordant cases (10%), 4 (57%) showed major variation from negative to positive, and in 3 cases with major discordance, the index tumor was negative for progesterone receptor, whereas a smaller focus was positive. A difference in HER2 expression was noted in 5 of 86 cases (6%). In only 5 of the 15 patients (33%) with discordant results, biomarker testing on additional foci would have been offered per the College of American Pathologists recommendations because of differences in histology or grading. Of the remaining 10 patients, 7 (70%) with positive results on smaller foci would have been deprived of appropriate adjuvant systemic treatment if the smaller focus had not been tested. Conclusions.— We propose that negative values expressed in the primary tumor be repeated routinely on additional ipsilateral synchronous tumors.
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Majidi, Shahram, Johanna T. Fifi, Travis R. Ladner, Jacques Lara-Reyna, Kurt A. Yaeger, Benjamin Yim, Neha Dangayach, et al. "Emergent Large Vessel Occlusion Stroke During New York City’s COVID-19 Outbreak." Stroke 51, no. 9 (September 2020): 2656–63. http://dx.doi.org/10.1161/strokeaha.120.030397.
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Background and Purpose: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak. Methods: This is a retrospective, observational case series. Data were collected from all patients who presented with ELVO to the Mount Sinai Health System Hospitals across New York City during the peak 3 weeks of hospitalization and death from COVID-19. Patients’ demographic, comorbid conditions, cardiovascular risk factors, COVID-19 disease status, and clinical presentation were extracted from the electronic medical record. Comparison was made between COVID-19 positive and negative cohorts. The incidence of ELVO stroke was compared with the pre-COVID period. Results: Forty-five consecutive ELVO patients presented during the observation period. Fifty-three percent of patients tested positive for COVID-19. Total patients’ mean (±SD) age was 66 (±17). Patients with COVID-19 were significantly younger than patients without COVID-19, 59±13 versus 74±17 (odds ratio [95% CI], 0.94 [0.81–0.98]; P =0.004). Seventy-five percent of patients with COVID-19 were male compared with 43% of patients without COVID-19 (odds ratio [95% CI], 3.99 [1.12–14.17]; P =0.032). Patients with COVID-19 were less likely to be White (8% versus 38% [odds ratio (95% CI), 0.15 (0.04–0.81); P =0.027]). In comparison to a similar time duration before the COVID-19 outbreak, a 2-fold increase in the total number of ELVO was observed (estimate: 0.78 [95% CI, 0.47–1.08], P ≤0.0001). Conclusions: More than half of the ELVO stroke patients during the peak time of the New York City’s COVID-19 outbreak were COVID-19 positive, and those patients with COVID-19 were younger, more likely to be male, and less likely to be White. Our findings also suggest an increase in the incidence of ELVO stroke during the peak of the COVID-19 outbreak.
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Moss, Marie, Jordan Ehni, Ilka Herbison, Kristine B. Rabii, Caitlin Koepsell, Eileen Devries, Rina Fetman, et al. "505. Use of CLABSI Prevention Bundle Audits to Decrease CLABSI Rates in COVID Positive ICU Patients in an Acute Care Hospital in New York City During the COVID-19 Epidemic." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S318—S319. http://dx.doi.org/10.1093/ofid/ofaa439.699.
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Abstract Background Mount Sinai Beth Israel (MSBI) is a 220 bed acute care hospital located in the Manhattan borough of Manhattan in New York City. Prior to COVID-19, the hospital had one 16-bed Medical/Surgical ICU. When the COVID epidemic struck New York City, the MSBI ED was flooded with critically ill patients requiring ICU care. Seven other ICUs were opened, all of which were filled with COVID patients. The majority of these patients required central lines for the multiple antibiotics, steroids, and vasopressors they needed to survive. Agency RNs were brought in to care for ICU patients. In April, the MSBI Infection Prevention (IP) department received several CLABSI notifications through its data mining system. The IPs were alarmed at the number of CLABSIs occurring in ICU COVID patients with central lines. ICU CLABSI Rates in an Acute Care Hospital During the COVID-19 Epidemic in New York City Methods A baseline assessment, using the central line maintenance bundle, was conducted on all COVID patients with central lines. This assessment revealed issues with central line maintenance, including: undated, bloody, and non-intact dressings, poorly placed CHG impregnated disks; blood in end-caps, and missing alcohol impregnated caps on ports. The decision was made to bring in infusion RNs from an outpatient system site to perform daily rounds on central lines. These RNs performed daily intensive maintenance bundle rounds for a month during the COVID epidemic. During their rounds, ICU nurses and managers were notified of central line dressing and cap issues and educated on how to correct them. These RNs also e-mailed daily reports of their findings to Nursing Leadership for their review. Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYC Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYC Results Central line rounds performed after the intervention showed a great improvement in compliance with the central line maintenance bundle, from 13% during the first rounds performed in April, to 88% in May, less than a month after these rounds started. Since this intervention, the ICU CLABSI rate has decreased from a rate of 3.3 per 1,000 central line days in April and May to a current rate of 0. Conclusion The timely identification and root cause analysis of a problem must be followed by timely, intensive, and repeated interventions that are designed to attack the causes of problems at their source. After the crisis period is over, the interventions must be maintained to ensure that gains made can be sustained. Disclosures All Authors: No reported disclosures
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Saber, Alan A., Andre Aboolian, Raymond D. Laraja, Howard Baron, and Kayane Hanna. "HIV/AIDS and the Risk of Deep Vein Thrombosis: A Study of 45 Patients with Lower Extremity Involvement." American Surgeon 67, no. 7 (July 2001): 645–47. http://dx.doi.org/10.1177/000313480106700711.
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Many aspects of acquired immunodeficiency syndrome (AIDS) have been described in detail in the literature. However, there have been very few articles on the phenomenon of deep vein thrombosis (DVT) in the lower extremities of human immunodeficiency virus (HIV)/AIDS patients. The objective of this communication is to record the incidence of DVT in HIV/AIDS patients and the risks for development of embolic events and to emphasize the need for prevention and for the vigorous treatment of this complication. We conducted a retrospective review of HIV/AIDS-infected patients with DVT admitted to Mount Sinai School of Medicine/Cabrini Hospital in New York during the last 5 years. Analysis includes demographic data; risk factors for HIV/AIDS infection; associated medical problems; recent surgery; and laboratory findings including CD4 counts, platelet counts, prothrombin times, partial thromboplastin times, and plasma albumin levels; and image studies. From January 1995 to January 2000 4752 HIV/AIDS-infected patients were admitted. Of those admitted to the hospital 45 (0.95%) were found to have DVT. There were 36 males and nine females (mean age 43 years). Of the 45 patients 38 had infectious complications and 13 developed a malignancy. The distribution of the thromboses were the femoral vein in 23 patients, the popliteal vein in 20 patients, and the iliofemoral system in 2 patients. Twelve patients had recurrent DVT and three patients developed a pulmonary embolism. HIV/AIDS infection is a considerable risk for development of DVT in the lower extremity. Statistically DVT in HIV/AIDS is approximately 10 times greater than in the general population. Emphasis upon prevention and vigorous treatment of DVT is recommended.
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Munoz, Lizette, Blair MacKenzie, Audrey Chun, Shamsi Fani, Susana Lavayen, and Stephanie Chow. "Acute Life Interventions, Goals, and Needs Program: Social Determinants of Health Among the Most Vulnerable." Innovation in Aging 4, Supplement_1 (December 1, 2020): 393–94. http://dx.doi.org/10.1093/geroni/igaa057.1267.
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Abstract The Acute Life interventions Goals and Needs program(ALIGN) at Mount Sinai Hospital in New York City, is an inter-professional team dedicated to offering temporary intensive ambulatory care services to the most complex older patient population. This allows us to care for the most vulnerable population which often incur multiple hospitalizations, emergency room visits. Mr.C is a 81 yo male with past medical history of Chronic COPD, Depression, Gait instability, Mild Neuro-cognitive disorder, Hearing Loss, Coronary artery disease. Most significantly he had 3 ED visits, 1 admission, where he was found on the floor of his apartment after two days, by a meals on wheels volunteer. Team conducted a comprehensive assessment of Mr.C’s social determinants of health and compiled a care plan. We learned that Mr.C does not like to bother others therefore found it difficult to seek help. Team built intensive rapport and gained his trust to help simplify medications, increase engagement and explore barriers to home care. Mr.C was connected to several community agencies including, meals on wheels for more stable food access, psychiatry to discuss depression and isolation, adult protective services for deep cleaning,financial management, pharmacy for blister packing, home care services and case management to continue encouragement with care plan. Mr.C is now able to reach out to the team as needed and has a navigator to help with managing care. This is one of many cases ALIGN encounters, that often go undetected due to comprehensive inter-professional care needed and minimal time given in traditional primary care.
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Sacchi De Camargo Correia, Guilherme, Sridevi Rajeeve, and Lawrence Cytryn. "Factor XI Deficiency in Pregnant Women: A Case-Series from a New York City Hospital." Blood 136, Supplement 1 (November 5, 2020): 16. http://dx.doi.org/10.1182/blood-2020-141709.
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Factor XI (FXI) deficiency is a rare bleeding disorder. In the general population, prevalence is estimated to be 1:1 million people for the homozygous presentation (PMID: 25100430). Nonetheless, in individuals of Ashkenazi and Iraqi Jewish ancestry, the prevalence of heterozygous cases is approximately 8% (PMID: 7811996). However, these numbers may be underestimates, as some patients are asymptomatic and, so, not accounted for. Pregnant women are a special population, as FXI deficiency may pose an increased risk during pregnancy and delivery. This study describes the experience of a General Hematology Outpatient Service to which pregnant women with FXI deficiency are referred. This case series aims to describe the clinical course of these patients, and any complications and interventions they may have experienced during pregnancy and delivery. This retrospective study identified a group of 49 patients with FXI deficiency who were evaluated by a single practitioner at the Hematology Outpatient Service at Mount Sinai West, in New York City, between October 2016 and February 2020. Patients were found to be FXI deficient on routine genetic screening early in their obstetric care. Their charts were reviewed, including epidemiological data, notes from Hematology and Obstetric Clinics and from the admission for delivery and laboratory results. Four patients were excluded from the final analysis: 3 who were not pregnant, and 1 who did not have FXI deficiency. Patients were seen in by the Hematology Service at least once during their pregnancy. FXI activity was measured at least twice during pregnancy: at the initial visit, and at about gestational week 37. The data were analyzed to obtain the mean and standard deviation for the most relevant clinical parameters. A comparison between FXI activity at the first visit and at last visit near term was made with a paired T-test. The included group of 45 patients presented a mean age at delivery of 34.09 years (range 26-45 years). Genetic data was available for 42 patients, with 2.38% being homozygous. Ethnicities were described for 39 patients, and 71.79% were identified as Ashkenazi Jewish. Among 39 patients who had their FXI gene (gene NM_000128.3) mutations described, the c.901T>C, p.F301L mutation was present in 61.54% of them. The mean FXI activity measured in the first appointment was 60.18%, (range 4-220%), while the mean FXI activity in week 37 of pregnancy was 52.08% (range 13-118%). When comparing the FXI activity on the first appointment and around week 37, no statistically significant difference was found (p=0.17). Four patients received preventive interventions on delivery. One patient was treated with Tranexamic Acid (TXA) and Fresh Frozen Plasma (FFP) transfusion due to a FXI activity of 21% on week 37, and received general anesthesia. Two patients received transfusion of FFP alone: 1 of them due to an elevated aPTT (57.4s) on delivery date, with no anesthesia on delivery; and the other one as a preventive measure in a patient with a FXI of 45% on week 37, but who was planned for a neuraxial block. A FXI activity of 40% is the cutoff for a neuraxial block by the Anesthesiology Department at our hospital. One patient was treated with TXA due to a borderline FXI activity of 42% and a personal history of bleeding on surgical procedures. She had an opioid patient-controlled analgesia on delivery. For the detailed data regarding mean blood loss on delivery, postpartum blood loss, and complete Hematologic and Obstetric data, see tables 1 and 2, and figures 1 and 2. Figure 3 presents a data comparison between the 2 most common genotypes observed. In our case series, no patient experienced bleeding complications during pregnancy or delivery. Monitoring FXI levels and aPTT throughout pregnancy and before delivery remains as the standard medical care (PMID: 27699729). The difference between FXI levels earlier in pregnancy and near delivery was not statistically significant, as noted in previous studies (PMID: 15199489). Checking FXI activity throughout pregnancy may not be necessary, and one measurement might be enough. Further study might be able to answer this question, as the optimal management of these patients remains a work in progress. Evidence for a reliable threshold FXI activity at which neuraxial anesthesia could be safely performed will be a valuable finding. Continuation of our study will allow for further data regarding the management of FXI deficient pregnant women. Disclosures No relevant conflicts of interest to declare.
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Griffin, Jacqueline R., Tomi Jun, Bobby Chi-Hung Liaw, Sunny Guin, Che-Kai Tsao, Vaibhav G. Patel, Michael Rossi, et al. "Clinical utility of next-generation sequencing for prostate cancer in the context of a changing treatment landscape." Journal of Clinical Oncology 40, no. 6_suppl (February 20, 2022): 112. http://dx.doi.org/10.1200/jco.2022.40.6_suppl.112.
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112 Background: Next-generation sequencing (NGS) is increasingly common in clinical practice, but its clinical utility may depend on the availability of sequencing-directed therapies (SDT). There were no FDA-approved SDTs in prostate cancer (PCa) until 2020, when PARP inhibitors olaparib and rucaparib were approved for tumors bearing alterations in certain homologous recombination repair (HRR) genes. We assessed the clinical utility of NGS in PCa before and after the approval of these agents in a single academic medical center. Methods: This was a retrospective single-center study including all PCa patients seen at Mount Sinai Hospital (New York, NY) between 2018–2021 who received NGS via the 161-gene Sema4 Signal Solid Tumor Panel. Clinical data were extracted from the Mount Sinai electronic medical record using a proprietary automated pipeline with limited manual curation (Sema4 PRODB). The primary outcome was clinical utility in metastatic PCa, defined as the proportion of metastatic PCa patients who received SDT. Secondary outcomes included time-to-next-treatment (TTNT, defined as time from SDT start to the start of next systemic therapy) and the proportion of patients with clinically actionable (as of 9/2021) alterations, defined as either Tier 1 (associated with FDA-approved treatments in prostate cancer) or Tier 2 (associated with either off-label or investigational agents). Results: The cohort consisted of 332 PCa patients; 51% (N = 170) were sequenced in 2020 or later. The median age at diagnosis was 65 (IQR 12). The most advanced stage documented was localized for 39% (N = 129) and metastatic for 61% (N = 203). Overall, 167 actionable alterations were identified in 125 patients (38% of cohort). Of the actionable alterations, 31% (N = 51) were Tier 1 and 69% (N = 116) were Tier 2. Of the 44 patients with Tier 1 alterations, 8 (18%) received SDT (all received olaparib). The proportion of metastatic patients receiving olaparib increased from 1% (2/145) before 2020 to 10% (6/58) during or after 2020 (p = 0.008). Of the 36 patients not receiving olaparib: 20 were sequenced before FDA approval and were treated with an alternative systemic therapy; 8 had localized disease and were not eligible; 8 had limited follow-up or unknown treatment status. For those who received olaparib, median TTNT was 5 months. Conclusions: In this single-center retrospective cohort, clinical utility of NGS was linked to treatment landscape. Increases in NGS test volume and olaparib use coincided with the approval of PARP inhibitors for patients with HRR-mutated prostate cancers. Notably, NGS was used to match patients to off-label/ investigational olaparib before its FDA approval.[Table: see text]
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Ilonzo, Nicole, Issam Koleilat, Vivek Prakash, John Charitable, Karan Garg, Daniel Han, Peter Faries, and John Phair. "The Effect of COVID-19 on Training and Case Volume of Vascular Surgery Trainees." Vascular and Endovascular Surgery 55, no. 5 (January 11, 2021): 429–33. http://dx.doi.org/10.1177/1538574420985775.
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Background: In many facilities, the coronavirus disease (COVID-19) pandemic caused suspension of elective surgery. We therefore sought to determine the impact of this on the surgical experience of vascular trainees. Methods: Surgical case volume, breadth, and the participating trainee post-graduate level from 3 large New York City Hospitals with integrated residency and fellowship programs (Mount Sinai, Montefiore Medical Center/Albert Einstein College of Medicine, and New York University) were reviewed. Procedures performed between February 26 to March 25, 2020 (pre-pandemic month) and March 26 to April 25, 2020 (peak pandemic period) were compared to those performed during the same time period in 2019. The trainees from these programs were also sent surveys to evaluate their subjective experience during this time. Results: The total number of cases during the month leading into the peak pandemic period was 635 cases in 2019 and 560 cases in 2020 (12% decrease). During the peak pandemic period, case volume decreased from 445 in 2019 to 114 in 2020 (74% reduction). The highest volume procedures during the peak pandemic month in 2020 were amputations and peripheral cases for acute limb ischemia; during the 2019 period, the most common cases were therapeutic endovascular procedures. There was a decrease in case volume for vascular senior residents of 77% and vascular junior and midlevel residents of 75%. There was a 77% survey response rate with 50% of respondents in the senior years of training. Overall, 20% of respondents expressed concern about completing ACGME requirements due to the COVID-19 pandemic. Conclusions: Vascular surgery-specific clinical educational and operative experiences during redeployment efforts have been limited. Further efforts should be directed to quantify the impact on training and to evaluate the efficacy of training supplements such as teleconferences and simulation.
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Farber, Jeffrey Ian, and Randall F. Holcombe. "Clinical documentation improvement as a quality metric in oncology." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 123. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.123.
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123 Background: With the rapid pace of healthcare reimbursement transformation from a fee-for-service to a fee-for-value system, clinical documentation is increasingly recognized as a critical area of focus for quality improvement. Engaging busy physicians to improve their clinical documentation is a challenging endeavor. Many hospitals utilize clinical documentation improvement specialists to query physicians for more specific and comprehensive clinical documentation. In this paper, we will report on a novel, complementary, and replicable approach we utilized to improve clinical documentation in the medical oncology clinical service line at the Mount Sinai Hospital in New York City. Methods: We organized a team of stakeholder physicians, clinical documentation specialists, clinical informaticists, and data analysts in July 2013 to address a perceived gap in publicly-reported severity-adjusted quality metrics in medical oncology. We used University Health System Consortium data to conduct a detailed comparative analysis of the rates of coding for common and important secondary ICD-9 diagnoses on inpatient claims by base Diagnosis Related Group (DRG). A list of 34 diagnoses was targeted for improvement in the accuracy and specificity of clinical documentation. We then developed an electronic medical record tool to assist clinicians in real-time clinical documentation. We rolled out a new quality metric with monthly reporting on CC/MCC (complication or comorbidity and major complication or comorbidity) capture rates to departmental leadership, provided educational outreach to front-line providers and developed additional non-electronic reminder tools for provider use. Results: We increased the overall CC/MCC capture rate from 88% to 94% and the case mix index (CMI) for the chemotherapy base MS-DRG from 1.11 to 1.28 from March 2013 to March 2014. The capture rate remained the same (6) or increased (18) in 82% of the targeted diagnoses. Conclusions: Adding clinical documentation metrics to the existing quality infrastructure, supported with comparative analytical data and EMR tools, can drive sustainable improvements in clinical documentation which supports publicly-reported severity-adjusted quality measures.
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Francke, Jordan A., Phillip Groden, Christopher Ferrer, Dennis Bienstock, Danielle L. Tepper, Tania P. Chen, Charles Sanky, Tristan R. Grogan, and Matthew A. Weissman. "Remote enrollment into a telehealth-delivering patient portal: Barriers faced in an urban population during the COVID-19 pandemic." Health and Technology 12, no. 1 (November 8, 2021): 227–38. http://dx.doi.org/10.1007/s12553-021-00614-x.
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AbstractTelehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40–59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.
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Hamon, Pauline, Assaf Magen, Joel Kim, Mark Buckup, Leanna Troncoso, Steven Hamel, Jessica Le Berichel, et al. "685 Characterization of molecular and spatial diversity of macrophages in hepatocellular carcinoma." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A713. http://dx.doi.org/10.1136/jitc-2021-sitc2021.685.
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BackgroundHepatocellular carcinoma (HCC) has a dismal prognosis, and though checkpoint blocking antibodies have significantly improved patient outcome, many patients remain left out, highlighting the need to identify additional immune target to enhance therapeutic immunity. Macrophages (MF) are an abundant and heterogeneous population in the tumor microenvironment (TME), and are associated with a poor prognosis in multiple tumor types, including HCC, however, their molecular and functional diversity is still poorly understood.MethodsWe analyzed the molecular and spatial organization patterns of immune cells within the TME and adjacent tissue of 26 resected HCC lesions using single-cell RNA sequencing and multiplex immunohistochemistry (IHC).ResultsWe found that Kupffer cells, the self-renewing tissue-resident macrophages in liver tissue, are lacking from the TME, which is dominated by monocyte-derived macrophages. ScRNAseq followed by high-resolution clustering identified distinct MF molecular programs within the monocyte-derived macrophage compartment. One MF subset expressed a shared signature with monocytes including FCN1, S100A8 and T cell activation genes like CXCL9 and IL32. Conversely, one subset of MF expressed FOLR2, SEPP1 and genes of the complement (C1Qs), a program shared with KC in the adjacent tissue, and include another intratumoral subset enriched for the expression of TREM2 and GPNMB. Guided by these results, we are developing an IHC antibody panel that allows to visualize distinct MF localization in the TME. Intratumoral MF interface with, and potentially regulate, the T cell compartment within the TME. We are analyzing HCC tumor lesions in our treatment-naïve cohort and in patients treated with neoadjuvant anti-PD-1 therapy (NCT03916627) to study co-localization and direct interaction of MF and T cells using physically-interacting cell sequencing (PICseq). This analysis enables us to identify MF with direct cell-cell contact with T cells, and our preliminary analysis demonstrates an enrichment in MF with an immunosuppressive phenotype. We are also using spatial transcriptomic to map molecular programs of MF in the TME, that we will corroborated with additional patients.ConclusionsTaken together, our data provide a new understanding of intratumoral MF diversity and highlight the presence of specific immunoregulatory MF programs unique to tumor lesions, with subsets of these MF found to be directly interacting with T cells, potentially modulating anti-tumor responsiveness. Our analysis of resected tumor from anti-PD-1 treated patients, will allow us to correlate MF programs, and direct T cell interaction, with clinical response, and will inform therapeutic trials targeting specific MF populations so as to improve clinical efficacy of cancer immunotherapy.Trial RegistrationNCT03916627Ethics ApprovalSamples of tumor and non-involved liver were obtained from surgical specimens of patients undergoing resection at Mount Sinai Hospital (New York, NY) after obtaining informed consent in accordance with a protocol reviewed and approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai (RUTH Human Subjects Electronic Submission System 18–00407 and 20–04150) and in collaboration with the Biorepository and Department of Pathology.
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Kini, Annapoorna, Davide Cao, Matteo Nardin, Samantha Sartori, Zhongjie Zhang, Carlo Andrea Pivato, Mauro Chiarito, et al. "Types of myocardial injury and mid-term outcomes in patients with COVID-19." European Heart Journal - Quality of Care and Clinical Outcomes 7, no. 5 (August 30, 2021): 438–46. http://dx.doi.org/10.1093/ehjqcco/qcab053.
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Abstract Aims To evaluate the acute and chronic patterns of myocardial injury among patients with coronavirus disease-2019 (COVID-19), and their mid-term outcomes. Methods and results Patients with laboratory-confirmed COVID-19 who had a hospital encounter within the Mount Sinai Health System (New York City) between 27 February 2020 and 15 October 2020 were evaluated for inclusion. Troponin levels assessed between 72 h before and 48 h after the COVID-19 diagnosis were used to stratify the study population by the presence of acute and chronic myocardial injury, as defined by the Fourth Universal Definition of Myocardial Infarction. Among 4695 patients, those with chronic myocardial injury (n = 319, 6.8%) had more comorbidities, including chronic kidney disease and heart failure, while acute myocardial injury (n = 1168, 24.9%) was more associated with increased levels of inflammatory markers. Both types of myocardial injury were strongly associated with impaired survival at 6 months [chronic: hazard ratio (HR) 4.17, 95% confidence interval (CI) 3.44–5.06; acute: HR 4.72, 95% CI 4.14–5.36], even after excluding events occurring in the first 30 days (chronic: HR 3.97, 95% CI 2.15–7.33; acute: HR 4.13, 95% CI 2.75–6.21). The mortality risk was not significantly different in patients with acute as compared with chronic myocardial injury (HR 1.13, 95% CI 0.94–1.36), except for a worse prognostic impact of acute myocardial injury in patients <65 years of age (P-interaction = 0.043) and in those without coronary artery disease (P-interaction = 0.041). Conclusion Chronic and acute myocardial injury represent two distinctive patterns of cardiac involvement among COVID-19 patients. While both types of myocardial injury are associated with impaired survival at 6 months, mortality rates peak in the early phase of the infection but remain elevated even beyond 30 days during the convalescent phase.
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Magen, Assaf, Assaf Magen, Pauline Hamon, Myron Schwartz, Thomas Marron, Alice Kamphorst, and Miriam Merad. "361 Heterogeneity of PD-1hi T cells associates with response to PD-1 blockade in hepatocellular carcinoma." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A388. http://dx.doi.org/10.1136/jitc-2021-sitc2021.361.
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BackgroundBlockade of the PD-1 pathway is a therapeutic strategy to reinvigorate T cell responses against tumors, and when combined with other biologic therapies in the first line setting this achieves significant clinical response in about 25% of hepatocellular carcinoma (HCC) patients. We hypothesize that phenotypic diversity of tumor infiltrating T cells can explain, at least partially, the disparate clinical responses to immunotherapy.MethodsHere, we analyze the molecular diversity of T cells in tumor, adjacent tissue and tumor-draining lymph node (dLN) by single-cell RNA sequencing of tissue from 23 patients with early stage HCC treated by neoadjuvant PD-1 blockade (NCT03916627).ResultsWe identify distinct subsets of PD-1hi T cells with varying degrees of exhaustion and effector gene programs. Compared to parallel analysis of untreated HCC tumors, we observed that PD-1 blockade resulted in expansion of PD-1hi T cells in the tumor, regardless of clinical response. PD-1hi T cells subsets were highly clonal and enriched in the tumor compared to adjacent tissue, suggesting specificity to tumor antigens. Remarkably, within the PD-1hi T cell population we find an association between specific transcriptomic phenotype that correlates with response to PD-1 blockade. Using T cell receptor (TCR) sequencing to study the differentiation patterns between T cell states, we found that clonotypes present among expanded PD-1hi T cells were also found in CD8 effector cells; these data identify characteristic clonally related T cell populations that are enriched in clinical responders. Furthermore, we find that dLN harbor clonotypes of PD-1hi T cells expanded in tumor. In the dLN, these potentially tumor-specific T cells have features of activation and exhaustion suggesting a continuous role of dLN in anti-tumor responses. This study suggests a link between particular PD-1hi T cell subsets and responsiveness to PD-1 blockade.ConclusionsThese results will be corroborated with 8 additional patient samples in which we will further analyze the role of tumor-specific T cells in dLN. Furthermore, our ongoing sequencing of pre-treatment lesions will enable monitoring of T cell clonal expansion, and additionally transcriptomic characterization of these samples will be correlated with post-treatment T cell programs to test predictive potential of baseline lymphoid phenotype. Correlations of these phenotypes with response to PD-1 blockade will allow for validation of predictive biomarkers, and characterizing these T cell programs in the dLN and the tumor microenvironment will enable superior and personalized therapeutic interventions.Ethics ApprovalSamples of tumor and non-involved liver were obtained from surgical specimens of patients undergoing resection at Mount Sinai Hospital (New York, NY) after obtaining informed consent in accordance with a protocol reviewed and approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai (RUTH Human Subjects Electronic Submission System 18-00407 and 20-04150) and in collaboration with the Biorepository and Department of Pathology.
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Fuller, Risa, Erin Moshier, Samantha E. Jacobs, Douglas Tremblay, Guido Lancman, Alexander Coltoff, Jessica Caro, John Mascarenhas, and Meenakshi Rana. "1090. Practicing Antimicrobial Stewardship: De-escalating Empiric Antibiotics in Patients with Acute Myelogenous Leukemia and Neutropenic Fever." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S387—S388. http://dx.doi.org/10.1093/ofid/ofz360.954.
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Abstract Background In the era of increased antibiotic resistance, minimizing the use of broad-spectrum antibiotics is essential. We sought to determine whether there was a difference in risk of recurrent fever in patients with acute myelogenous leukemia (AML) and neutropenic fever without an identifiable source in which antibacterials were de-escalated prior to neutrophil recovery compared with those that continued until recovery. Methods We performed a retrospective chart review of adult patients with AML undergoing induction chemotherapy at Mount Sinai Hospital in New York, NY from 2009–2017. Neutropenic fever was defined as a temperature of 100.4°F for 1 hour or single temperature of 101°F in a patient with an absolute neutrophil count (ANC) of less than 500 cells/μL. Febrile patients were treated with cefepime, piperacillin–tazobactam, or a carbapenem. De-escalation was defined as changing from one of these antibiotics to antibacterial prophylaxis such as levofloxacin, or discontinuing antibiotics. The primary outcome was recurrent neutropenic fever. Secondary outcomes were adverse events related to antibiotics, intensive care unit (ICU) transfer, and all-cause mortality. Results Of 390 AML patients undergoing induction chemotherapy, 135 had a neutropenic fever; of whom, 77 had no identifiable infectious source. Of those 77, 38 had antibiotics de-escalated prior to ANC recovery (“short”) and 39 had antibiotics continued until ANC recovery or discharge (“long”). Demographics were similar (Table 1). The median number of antibiotic days for the first fever was 9 in the short group and 15 in the long group (P = 0.0008) (Table 2). Risk of recurrent fever was 46% lower in the short group compared with the long group (hazard ratio 0.54, 95% CI: 0.34–0.88; P = 0.01). There was no significant difference in ICU transfer (P = 0.11) and in-hospital mortality (P = 0.36) between the short and long groups (Table 2). There were 7 adverse drug outcomes, 2 in the short group and 5 in the long group (Table 3). Conclusion Antibiotic de-escalation in AML patients with neutropenic fever with no identifiable infectious source was associated with a lower rate of recurrent fever without affecting ICU transfer, adverse drug events, and death. Physicians should consider de-escalation prior to ANC recovery in the appropriate setting. Disclosures All authors: No reported disclosures.