Vital Signs: Nature, Culture, Psychoanalysis. Charles Shepherdson. London, New York: Routledge, 2000.

Hypatia ◽  
2002 ◽  
Vol 17 (4) ◽  
pp. 247-251
Author(s):  
Ewa Plonowska Ziarek
Keyword(s):  
New York ◽  
Vital Signs

scholarly journals Vital signs assessed in initial clinical encounters predict COVID-19 mortality in an NYC hospital system

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Elza Rechtman ◽  
Paul Curtin ◽  
Esmeralda Navarro ◽  
Sharon Nirenberg ◽  
Megan K. Horton
Keyword(s):  
Machine Learning ◽  
New York ◽  
Clinical Decision Making ◽  
Care Delivery ◽  
Vital Signs ◽  
Clinical Decision ◽  
Rapid Identification ◽  
Gradient Boosting ◽  
Hospital System ◽  
Response Strategies

AbstractTimely and effective clinical decision-making for COVID-19 requires rapid identification of risk factors for disease outcomes. Our objective was to identify characteristics available immediately upon first clinical evaluation related COVID-19 mortality. We conducted a retrospective study of 8770 laboratory-confirmed cases of SARS-CoV-2 from a network of 53 facilities in New-York City. We analysed 3 classes of variables; demographic, clinical, and comorbid factors, in a two-tiered analysis that included traditional regression strategies and machine learning. COVID-19 mortality was 12.7%. Logistic regression identified older age (OR, 1.69 [95% CI 1.66–1.92]), male sex (OR, 1.57 [95% CI 1.30–1.90]), higher BMI (OR, 1.03 [95% CI 1.102–1.05]), higher heart rate (OR, 1.01 [95% CI 1.00–1.01]), higher respiratory rate (OR, 1.05 [95% CI 1.03–1.07]), lower oxygen saturation (OR, 0.94 [95% CI 0.93–0.96]), and chronic kidney disease (OR, 1.53 [95% CI 1.20–1.95]) were associated with COVID-19 mortality. Using gradient-boosting machine learning, these factors predicted COVID-19 related mortality (AUC = 0.86) following cross-validation in a training set. Immediate, objective and culturally generalizable measures accessible upon clinical presentation are effective predictors of COVID-19 outcome. These findings may inform rapid response strategies to optimize health care delivery in parts of the world who have not yet confronted this epidemic, as well as in those forecasting a possible second outbreak.

Devastating Consequences of Subway Accidents: Traumatic Amputations

2006 ◽  
Vol 72 (1) ◽  
pp. 74-76 ◽  
Author(s):  
Alexandra A. Maclean ◽  
Andrea M. O'Neill ◽  
H. Leon Pachter ◽  
Maurizio A. Miglietta
Keyword(s):  
New York ◽  
Glasgow Coma Scale ◽  
Limb Salvage ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Injury Severity ◽  
Vital Signs ◽  
Wound Infection Rate ◽  
Operative Procedures ◽  
Coma Scale

The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989–2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.

Trends in COVID-19 Risk-Adjusted Mortality Rates

2020 ◽  
Author(s):  
Leora I Horwitz ◽  
Simon A Jones ◽  
Robert J Cerfolio ◽  
Fritz Francois ◽  
Joseph Greco ◽  
...  
Keyword(s):  
New York ◽  
Hospital Mortality ◽  
Health System ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Mortality Rates ◽  
Standardized Mortality Ratio ◽  
Marginal Effect ◽  
Average Probability ◽  
Mortality Ratio

Early reports showed high mortality from coronavirus disease 2019 (COVID-19). Mortality rates have recently been lower, raising hope that treatments have improved. However, patients are also now younger, with fewer comorbidities. We explored whether hospital mortality was associated with changing demographics at a 3-hospital academic health system in New York. We examined in-hospital mortality or discharge to hospice from March through August 2020, adjusted for demographic and clinical factors, including comorbidities, admission vital signs, and laboratory results. Among 5,121 hospitalizations, adjusted mortality dropped from 25.6% (95% CI, 23.2-28.1) in March to 7.6% (95% CI, 2.5-17.8) in August. The standardized mortality ratio dropped from 1.26 (95% CI, 1.15-1.39) in March to 0.38 (95% CI, 0.12-0.88) in August, at which time the average probability of death (average marginal effect) was 18.2 percentage points lower than in March. Data from one health system suggest that mortality from COVID-19 is decreasing even after accounting for patient characteristics.

scholarly journals An Online Risk Calculator for Rapid Prediction of In-hospital Mortality from COVID-19 Infection

2021 ◽  
Author(s):  
Daniel S. Evans ◽  
Kyoung Min Kim ◽  
Xiaqing Jiang ◽  
Jessica Jacobson ◽  
Warren Browner ◽  
...  
Keyword(s):  
New York ◽  
Vital Signs ◽  
Inpatient Mortality ◽  
Operating Characteristics ◽  
Online Risk ◽  
Prediction Of Mortality ◽  
Receiver Operating Characteristics Curve ◽  
Rapid Prediction ◽  
Online Calculator ◽  
Boosted Decision Trees

AbstractPrediction of mortality from COVID-19 infection might help triage patients to hospitalization and intensive care. To estimate the risk of inpatient mortality, we analyzed the data of 13,190 adult patients in the New York City Health + Hospitals system admitted for COVID-19 infection from March 1 to June 30, 2020. They had a mean age 58 years, 40% were Latinx, 29% Black, 9% White and 22% of other races/ethnicities and 2,875 died. We used Machine learning (Gradient Boosted Decision Trees; XGBoost) to select predictors of inpatient mortality from demographics, vital signs and lab tests results from initial encounters. XGBoost identified O2 saturation, systolic and diastolic blood pressure, pulse rate, respiratory rate, age, and BUN with an Area Under the Receiver Operating Characteristics Curve = 94%. We applied CART to find cut-points in these variables, logistic regression to calculate odds-ratios for those categories, and assigned points to the categories to develop a score. A score = 0 indicates a 0.8% (95% confidence interval, 0.5 – 1.0%) risk of dying and ≥ 12 points indicates a 98% (97-99%) risk, and other scores have intermediate risks. We translated the models into an online calculator for the probability of mortality with 95% confidence intervals (as pictured):Abstract Figuredanielevanslab.shinyapps.io/COVID_mortality/

Vital Signs: Increased Medicaid Prescriptions for Preexposure Prophylaxis Against HIV infection — New York, 2012–2015

2015 ◽  
Vol 64 (46) ◽  
pp. 1296-1301 ◽  
Author(s):  
Franklin N. Laufer ◽  
Daniel A. O’Connell ◽  
Ira Feldman ◽  
Howard A. Zucker ◽  
Keyword(s):  
New York ◽  
Hiv Infection ◽  
Vital Signs ◽  
Preexposure Prophylaxis

A Prospective Analysis of Patients Presenting for Medical Attention at a Large Electronic Dance Music Festival

2016 ◽  
Vol 32 (1) ◽  
pp. 78-82 ◽  
Author(s):  
Matt S. Friedman ◽  
Alex Plocki ◽  
Antonios Likourezos ◽  
Illya Pushkar ◽  
Andrew N. Bazos ◽  
...  
Keyword(s):  
New York ◽  
Vital Signs ◽  
Medical Attention ◽  
Prospective Analysis ◽  
Mass Gathering ◽  
Dance Music ◽  
Electronic Dance Music ◽  
Music Festival ◽  
Mass Gathering Medicine ◽  
Patient Presentation

AbstractMass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a descriptive report of patients who presented for medical attention at an annual electronic dance music festival (EDMF). At this large, single EDMF in New York City (NYC; New York, USA), the frequency of patient presentation, the range of presentations, and interventions performed were identified.This descriptive report examined consecutive patients who presented to the medical tent of a summertime EDMF held at an outdoor venue with an active, mobile, bounded crowd. Alcohol was available for sale. Entry was restricted to persons 18 years and older. The festival occurred on three consecutive days with a total cumulative attendance of 58,000. Medical staffing included two Emergency Medicine physicians, four registered nurses, and 86 Emergency Medical Services (EMS) providers. Data collected included demographics, past medical history, vital signs, physical exam, drug and alcohol use, interventions performed, and transport decisions.Eighty-four patients were enrolled over 2.5 days. Six were transported and zero died. The ages of the subjects ranged from 17 to 61 years. Forty-three (51%) were male. Thirty-eight (45%) initially presented with abnormal vital signs; four (5%) were hyperthermic. Of these latter patients, 34 (90%) reported ingestions with 3,4-methylenedioxymethamphetamine (MDMA) or other drugs. Eleven (65%) patients were diaphoretic or mydriatic. The most common prehospital interventions were intravenous normal saline (8/84; 10%), ondansetron (6/84; 7%), and midazolam (3/84; 4%).Electronic dance music festivals are a growing trend and a new challenge for Mass-Gathering Medicine as new strategies must be employed to decrease TTHR and mortality. Addressing common and expected medical emergencies at mass-gathering events through awareness, preparation, and early, focused medical interventions may decrease PPR, TTHR, and overall mortality.FriedmanMS, PlockiA, LikourezosA, PushkarI, BazosAN, FrommC, FriedmanBW. A prospective analysis of patients presenting for medical attention at a large electronic dance music festival. Prehosp Disaster Med.2017; 32(1):78–82.

scholarly journals Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality

2021 ◽  
pp. 00018-2021
Author(s):  
Xiaoyu Song ◽  
Jiayi Ji ◽  
Boris Reva ◽  
Himanshu Joshi ◽  
Anna Pamela Calinawan ◽  
...  
Keyword(s):  
New York ◽  
Hospital Mortality ◽  
Research Question ◽  
Vital Signs ◽  
Adult Patients ◽  
Logistic Regression Models ◽  
Clinical Biomarkers ◽  
Therapeutic Anticoagulation ◽  
Emerging Treatments ◽  
D Dimer

Research QuestionClinical biomarkers that accurately predict mortality are needed for the effective management of patients with severe COVID-19 illness. In this study, we determine whether changes in D-dimer levels after anticoagulation are independently predictive of in-hospital mortality.Study DesignAdult patients hospitalised for severe COVID-19 who received therapeutic anticoagulation for thromboprophylaxis were identified from a large COVID-19 database of the Mount Sinai Health System in New York City. We studied the ability of post-anticoagulant D-dimer levels to predict in-hospital mortality, while taking into consideration 65 other clinically important covariates including patient demographics, comorbidities, vital signs and several laboratory tests.Results1835 adult patients with PCR-confirmed COVID-19 who received therapeutic anticoagulation during hospitalisation were included. Overall, 26% of patients died in the hospital. Significantly different in-hospital mortality rates were observed in patient groups based on mean D-dimer levels and trend following anticoagulation: 49% for the high mean-increase trend (HI) group; 27% for the high-decrease (HD) group; 21% for the low-increase (LI) group; and 9% for the low-decrease (LD) group (p<0.001). Using penalised logistic regression models to simultaneously analyze 67 clinical variables, the HI (adjusted odds ratios [ORadj]: 6.58, 95% CI 3.81–11.16), LI (ORadj: 4.06, 95% CI 2.23–7.38) and HD (ORadj: 2.37; 95% CI 1.37–4.09) D-dimer groups (reference: LD group) had the highest odds for in-hospital mortality among all clinical features.ConclusionChanges in D-dimer levels and trend following anticoagulation are highly predictive of in-hospital mortality and may help guide resource allocation and future studies of emerging treatments for severe COVID-19.

Spinal Cord Neuropathology in Human West NileVirus Infection

2004 ◽  
Vol 128 (5) ◽  
pp. 533-537 ◽  
Author(s):  
Jonathan D. Fratkin ◽  
A. Arturo Leis ◽  
Dobrivoje S. Stokic ◽  
Sally A. Slavinski ◽  
Roger W. Geiss
Keyword(s):  
Spinal Cord ◽  
New York ◽  
West Nile Virus ◽  
Gray Matter ◽  
Sympathetic Neurons ◽  
Vital Signs ◽  
The United States ◽  
Sympathetic Ganglia ◽  
Interval Length ◽  
West Nile

Abstract Context.—During the 1999 New York City West Nile virus (WNV) outbreak, 4 patients with profound muscle weakness, attributed to Guillain-Barré syndrome, were autopsied. These cases were the first deaths caused by WNV, a flavivirus, to be reported in the United States. The patients' brains had signs of mild viral encephalitis; spinal cords were not examined. During the 2002 national epidemic, several patients in Mississippi had acute flaccid paralysis. Electrophysiologic studies localized the lesions to the anterior horn cells in the spinal gray matter. Four of 193 infected patients in Mississippi died and were autopsied. All 4 experienced muscular weakness and respiratory failure that required intubation. Postmortem examinations focused on the spinal cord. Objective.—To emphasize apparent tropism of WNV for the ventral gray matter of the spinal cord. Design.—Cerebral hemispheres, basal ganglia, diencephalon, brainstem, cerebellum, and spinal cord sections were stained with hematoxylin-eosin and incubated with antibodies to T cells, B cells, and macrophages/microglial cells. Results.—We identified neuronophagia, neuronal disappearance, perivascular chronic inflammation, and microglial proliferation in the ventral horns of the spinal cord, especially in the cervical and lumbar segments. Loss of ganglionic neurons, nodules of Nageotte, and perivascular lymphocyte aggregates were found in dorsal root and sympathetic ganglia. Severity of cellular reaction was proportional to the interval length between patient presentation and death. Conclusion.—West Nile virus caused poliomyelitis. Injury to spinal and sympathetic ganglia mirrored the damage to the spinal gray matter. The disappearance of sympathetic neurons could lead to the autonomic instability observed in some WNV patients, including labile vital signs, hypotension, and potentially lethal cardiac arrhythmias.

Sign in / Sign up

Export Citation Format

Share Document