scholarly journals Clinical Features and Outcomes of Patients with Dementia Compared to an Aging Cohort Hospitalized During the Initial New York City COVID-19 Wave

2021 ◽  
pp. 1-12
Author(s):  
Amro A. Harb ◽  
RuiJun Chen ◽  
Herbert S. Chase ◽  
Karthik Natarajan ◽  
James M. Noble
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Risk Population ◽  
Columbia University ◽  
Code Status ◽  
Dementia Patients ◽  
Aging Populations

Background: Patients with dementia are vulnerable during the coronavirus disease 2019 (COVID-19) pandemic, yet few studies describe their hospital course and outcomes. Objective: To describe and compare the hospital course for COVID-19 patients with dementia to an aging cohort without dementia in a large New York City academic medical center. Methods: This was a single-center retrospective cohort study describing all consecutive patients age 65 or older with confirmed COVID-19 who presented to the emergency department or were hospitalized at New York-Presbyterian/Columbia University Irving Medical Center between March 6 and April 7, 2020. Results: A total of 531 patients were evaluated, including 116 (21.8%) with previously diagnosed dementia, and 415 without dementia. Patients with dementia had higher mortality (50.0%versus 35.4%, p = 0.006); despite similar comorbidities and complications, multivariate analysis indicated the association was dependent on age, sex, comorbidities, and code status. Patients with dementia more often presented with delirium (36.2%versus 11.6%, p <  0.001) but less often presented with multiple other COVID-19 symptoms, and these findings remained after adjusting for age and sex. Conclusion: Hospitalized COVID-19 patients with dementia had higher mortality, but dementia was not an independent risk factor for death. These patients were approximately 3 times more likely to present with delirium but less often manifested or communicated other common COVID-19 symptoms. For this high-risk population in a worsening pandemic, understanding the unique manifestations and course in dementia and aging populations may help guide earlier diagnosis and optimize medical management.

scholarly journals Palliative Care Team Involvement in Patients With COVID-19 in New York City

2020 ◽  
Vol 37 (10) ◽  
pp. 869-872 ◽  
Author(s):  
Reiichiro Obata ◽  
Tetsuro Maeda ◽  
Dahlia Rizk ◽  
Toshiki Kuno
Keyword(s):  
New York ◽  
Palliative Care ◽  
New York City ◽  
York City ◽  
Medical Center ◽  
Academic Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Care Group ◽  
Advanced Directives ◽  
Code Status

Background: With the highest number of cases in the world as of April 13, 2020, New York City (NYC) became the epicenter of the global coronavirus disease 2019 (COVID-19) pandemic. The data regarding palliative team involvement in patients with COVID-19, however, remains scarce. We aimed to investigate outcomes of palliative team involvement for the patients with COVID-19 in NYC. Methods: Consecutive 225 patients with confirmed COVID-19 requiring hospitalization in our urban academic medical center in NYC were analyzed. Patients were divided into 2 groups, those with a palliative care consult (palliative group: 14.2% [n = 32]) versus those with no palliative care consult (no palliative group: 85.8% [n = 193]). Results: The palliative group was older and had more comorbidities. During the hospital course, the palliative group had more intensive care unit stays, rapid response team activations, and more use of vasopressors ( P < .05). Patients with palliative care had higher rates of invasive mechanical ventilation than those without (46.9% vs 10.4%, P < .001). Cardiopulmonary resuscitation was performed in 12 patients (6.5% vs 5.2%, P = .77) and death rate was 100% in both subsets. Notably, initial code status was not different between the 2 groups, however, code status at discharge was significantly different between them ( P < .001). The rate of full code decreased by 70% in the palliative group and by 47.5% in the no palliative care group from admission to the time of death. Conclusions: Critically ill patients hospitalized for COVID-19 benefit from palliative team consults by helping to clarify advanced directives and minimize futile resuscitative efforts.

scholarly journals Clinical Impact of Rapid Molecular Diagnosis of Bloodstream Infections at an Academic Medical Center in New York City

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Matthew S. Simon ◽  
Angela Loo ◽  
Michael Satlin ◽  
Harjot Singh ◽  
Christina Chai ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Molecular Diagnosis ◽  
York City ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Clinical Impact ◽  
Academic Medical

scholarly journals Arsenic Exposure, Arsenic Metabolism, and Glycemia: Results from a Clinical Population in New York City

2021 ◽  
Vol 18 (7) ◽  
pp. 3749
Author(s):  
Fen Wu ◽  
Yu Chen ◽  
Ana Navas-Acien ◽  
Michela L. Garabedian ◽  
Jane Coates ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Medical Center ◽  
Academic Medical Center ◽  
Inorganic Arsenic ◽  
Clinical Population ◽  
Dimethylarsinic Acid ◽  
Urban Populations ◽  
Prospective Longitudinal

Little information is available regarding the glycemic effects of inorganic arsenic (iAs) exposure in urban populations. We evaluated the association of total arsenic and the relative proportions of arsenic metabolites in urine with glycemia as measured by glycated blood hemoglobin (HbA1c) among 45 participants with prediabetes (HbA1c ≥ 5.7–6.4%), 65 with diabetes (HbA1c ≥ 6.5%), and 36 controls (HbA1c < 5.7%) recruited from an academic medical center in New York City. Each 10% increase in the proportion of urinary dimethylarsinic acid (DMA%) was associated with an odds ratio (OR) of 0.59 (95% confidence interval (CI): 0.28–1.26) for prediabetes, 0.46 (0.22–0.94) for diabetes, and 0.51 (0.26–0.99) for prediabetes and diabetes combined. Each 10% increase in the proportion of urinary monomethylarsonic acid (MMA%) was associated with a 1.13% (0.39, 1.88) increase in HbA1c. In contrast, each 10% increase in DMA% was associated with a 0.76% (0.24, 1.29) decrease in HbA1c. There was no evidence of an association of total urinary arsenic with prediabetes, diabetes, or HbA1c. These data suggest that a lower arsenic methylation capacity indicated by higher MMA% and lower DMA% in urine is associated with worse glycemic control and diabetes. Prospective, longitudinal studies are needed to evaluate the glycemic effects of low-level iAs exposure in urban populations.

scholarly journals Relationship-Centered Care in a Novel Dual-Visit Model COVID Nursery Follow-Up Clinic

2020 ◽  
Vol 7 (6) ◽  
pp. 998-1001
Author(s):  
Minna Saslaw ◽  
Melissa E Glassman ◽  
M Kathleen Keown ◽  
Jordan Orange ◽  
Melissa S Stockwell
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Centered Care ◽  
To Come ◽  
Relationship Centered

The COVID Nursery Follow-Up Clinic at our academic medical center in New York City was established during the COVID-19 pandemic to provide care to infants born to SARS-CoV-2 positive mothers. We describe a novel dual-visit model utilizing telehealth and an in-person visit to provide timely, inclusive and relationship-centered care to the mother/infant couplet in a situation where the mother was unable to come to a traditional in-person visit, but the infant needed medically necessary in-person evaluation.

scholarly journals Telehealth Uptake into Prenatal Care and Provider Attitudes during the COVID-19 Pandemic in New York City: A Quantitative and Qualitative Analysis

2020 ◽  
Vol 37 (10) ◽  
pp. 1005-1014 ◽  
Author(s):  
Nigel Madden ◽  
Ukachi N. Emeruwa ◽  
Alexander M. Friedman ◽  
Janice J. Aubey ◽  
Aleha Aziz ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Prenatal Care ◽  
York City ◽  
Barriers To Care ◽  
Medical Center ◽  
Additional Patient ◽  
Columbia University ◽  
Provider Attitudes ◽  
Public Insurance

Objective This study aimed to (1) determine to what degree prenatal care was able to be transitioned to telehealth at prenatal practices associated with two affiliated hospitals in New York City during the novel coronavirus disease 2019 (COVID-19) pandemic and (2) describe providers' experience with this transition. Study Design Trends in whether prenatal care visits were conducted in-person or via telehealth were analyzed by week for a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. Visits were analyzed for maternal-fetal medicine (MFM) and general obstetrical faculty practices, as well as a clinic system serving patients with public insurance. The proportion of visits that were telehealth was analyzed by visit type by week. A survey and semistructured interviews of providers were conducted evaluating resources and obstacles in the uptake of telehealth. Results During the study period, there were 4,248 visits, of which approximately one-third were performed by telehealth (n = 1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of MFM visits, and 41.5% of clinic visits were performed via telehealth. A total of 36 providers completed the survey and 11 were interviewed. Accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers. In transitioning to telehealth, operational challenges were more significant for health clinics than for MFM and generalist faculty practices with patients receiving public insurance experiencing greater difficulties and barriers to care. Additional resources on the patient and operational level were required to optimize attendance at in-person and video visits for clinic patients. Conclusion Telehealth was rapidly implemented in the setting of the COVID-19 pandemic and was viewed favorably by providers. Limited barriers to care were observed for practices serving patients with commercial insurance. However, to optimize access for patients with Medicaid, additional patient-level and operational supports were required. Key Points

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