Telemedicine Uptake in a Geriatric Assessment Center During the COVID Crisis

Abstract The Yale New Haven Hospital Adler Geriatric Assessment Center is an outpatient consultative service that provides comprehensive assessment of older adults. As elsewhere, at Adler the COVID crisis necessitated a rapid shift in mode of care following a total cessation of in-person visits from late March 2020 to the end of May 2020. While our patients initially preferred telephone visits, video visits as a proportion of total scheduled increased from an average of 6% in the last full week of March to 24% in the last week in May possibly indicating increasing familiarity and comfort with the technology during that time. In addition, while video appointments as a proportion of total scheduled dropped rapidly in June 2020 as face-to-face appointments were reintroduced, we found a steady increase in the proportion of video visits from 3% in the first week of July 2020 to 7% in the second week of February 2021. To test for significance, we ran logistic regression models modelling the dichotomous video-appointment variable as the outcome and week and day of week as continuous variables. We found there was a significant increase in the proportion of appointments delivered over video both during the time when no face-to-face video appointments were allowed (OR=1.21, CI=1.13,1.30) and later in the pandemic (OR=1.04, CI=1.02,1.06). Durbin-Watson statistics were run to ensure that autocorrelation could be ignored. Sensitivity analyses limiting the sample to those with non-cancelled appointments gave similar results. Future analyses will examine patient clinical and demographic characteristics that might influence these trends.

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NIMG-64. TYPE OF BONY INVOLVEMENT PREDICTS GENOMIC SUBGROUP IN SPHENOID WING MENINGIOMAS

Neuro-Oncology ◽

10.1093/neuonc/noab196.562 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi144-vi144

Author(s):

Lan Jin ◽

Mark Youngblood ◽

Trisha Gupte ◽

Shaurey Vetsa ◽

Arushii Nadar ◽

...

Keyword(s):

Tumor Invasion ◽

Regression Models ◽

New Haven ◽

Who Grade ◽

Logistic Regression Models ◽

Whole Exome ◽

Grade Ii ◽

Bony Involvement ◽

Recurrence Patterns ◽

Haven Hospital

Abstract OBJECTIVE As sphenoid wing meningiomas (SWMs) are associated with varying degrees of bony involvement, we sought to understand potential relationships between genomic subgroup and this feature. METHODS Patients treated at Yale-New Haven Hospital for SWM were reviewed. Genomic subgroup was determined via whole exome sequencing, while the extent of bony involvement was radiographically classified as frank tumor invasion (TI), hyperostosis only (HOOs), or both (TI+HO). Among additional clinical variables collected, a subset of tumors was identified as spheno-orbital meningiomas (SOMs). Predictive logistic regression models were developed for genomic subgroups based on pre-operative clinical features. RESULTS Among 64 SWMs, 53% had HOO, 9% had TI, and 14% had TI+HO; nine SOMs were identified. Tumors with invasion (i.e., TI or TI+HO) were more likely to be WHO grade II (p: 0.028). Additionally, tumors with invasion were nearly 30 times more likely to harbor NF2 mutations (OR: 27.6; p: 0.004), while hyperostosis only (without frank tumor invasion) were over 4 times more likely to have a TRAF7 mutation (OR: 4.5; p: 0.023). SOMs were a significant predictor of underlying TRAF7 mutation (OR: 10.21; p: 0.004). CONCLUSIONS SWMs with invasion into bone tend to be higher grade and are more likely to be NF2 mutated, while SOMs and those with hyperostosis are associated with TRAF7 variants. Pre-operative prediction of molecular subtypes based on radiographic bony characteristics may have significant biological and clinical implications based on known recurrence patterns associated with genomic drivers.

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Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

10.1101/2021.01.01.20249069 ◽

2021 ◽

Author(s):

Joseph T. King ◽

James S. Yoon ◽

Zachary M. Bredl ◽

Joseph P. Habboushe ◽

Graham A. Walker ◽

...

Keyword(s):

Veterans Health Administration ◽

Sensitivity Analyses ◽

Veterans Health ◽

Health Administration ◽

New Haven ◽

Short Term ◽

Short Term Mortality ◽

Patient Subgroups ◽

Haven Hospital ◽

Over Time

AbstractBackgroundThe Veterans Health Administration COVID-19 (VACO) Index incorporates age, sex, and pre-existing comorbidity diagnoses readily available in the electronic health record (EHR) to predict 30-day all-cause mortality in both inpatients and outpatients infected with SARS-CoV-2. We examined the performance of the Index using data from Yale New Haven Hospital (YNHH) and national Medicare data overall, over time, and within important patient subgroups.Methods and findingsWith measures and weights previously derived and validated in a national Veterans Healthcare Administration (VA) sample, we evaluated the accuracy of the VACO Index for estimating inpatient (YNHH) and both inpatient and outpatient mortality (Medicare) using area under the receiver operating characteristic curve (AUC) and comparisons of predicted versus observed mortality by decile (calibration plots). The VACO Index demonstrated similar discrimination and calibration in both settings, over time, and among important patient subgroups including women, Blacks, Hispanics, Asians, and Native Americans. In sensitivity analyses, we allowed component variables to be re-weighted in the validation datasets and found that weights were largely consistent with those determined in VA data. Supplementing the VACO Index with body mass index and race/ethnicity had no effect on discrimination.ConclusionAmong COVID-19 positive individuals, the VACO Index accurately estimates risk of short-term mortality among a wide variety of patients. While it modestly over-estimates risk in recent intervals, the Index consistently identifies those at greatest relative risk. The VACO Index could identify individuals who should continue practicing social distancing, help determine who should be prioritized for vaccination, and among outpatients who test positive for SARS-CoV-2, indicate who should receive greater clinical attention or monoclonal antibodies.

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Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

Scientific Reports ◽

10.1038/s41598-021-87409-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoling Zhang ◽

Jingjing Zhang ◽

Jiamei Li ◽

Ya Gao ◽

Ruohan Li ◽

...

Keyword(s):

Blood Glucose ◽

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Venous Blood ◽

Sensitivity Analyses ◽

Icu Mortality ◽

Logistic Regression Models ◽

The Mean ◽

The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

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Incidence of hypocalcemia in patients receiving denosumab for prevention of skeletal-related events in bone metastasis

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155216628325 ◽

2016 ◽

Vol 23 (3) ◽

pp. 179-184 ◽

Cited By ~ 10

Author(s):

Prakirthi Yerram ◽

Shraddha Kansagra ◽

Osama Abdelghany

Keyword(s):

Risk Factors ◽

Bone Metastasis ◽

Calcium Supplementation ◽

Common Side Effect ◽

New Haven ◽

Study Population ◽

Skeletal Related Events ◽

Kidney Insufficiency ◽

Grade 3 ◽

Haven Hospital

Background Denosumab therapy is commonly used for the prevention of skeletal-related events in patients with bone metastasis. However, a common side effect of denosumab is hypocalcemia. Objective The aim of the study is to determine the incidence of hypocalcemia in patients receiving denosumab for prevention of skeletal-related events in bone metastasis and evaluate risk factors for developing hypocalcemia. Methods This was a retrospective medication use evaluation reviewing the incidence of hypocalcemia in patients receiving outpatient denosumab for prevention of skeletal-related events at Yale–New Haven Hospital. Additionally, various risk factors were reviewed to determine their risk of developing hypocalcemia. Results As per Common Terminology Criteria for Adverse Events v4.03, of the 106 patients included in the study population, 37 (35%) patients had an incidence of hypocalcemia within 30 days of denosumab administration. Fourteen patients (13.2%) had an incidence of grade 1, 13 patients (12.3%) had an incidence of grade 2 hypocalcemia, and 7 patients (6.6%) had an incidence of grade 3 hypocalcemia. Grade 4 hypocalcemia occurred in three (2.8%) patients. Calcium supplementation did not decrease the risk of developing hypocalcemia. Patients who had one or more episodes of acute kidney insufficiency were at a higher risk of developing hypocalcemia (odds ratio = 7.5 (95% confidence interval = 1.8–36.3), p = 0.001). Conclusion This study found that the overall incidence of hypocalcemia and severe hypocalcemia was higher than reported in clinical trials. Additionally, calcium supplementation did not have an effect on incidence of hypocalcemia, while patients who experienced acute kidney insufficiency while on denosumab had a higher likelihood of developing hypocalcemia.

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Setting – based prevalence and correlates of central obesity: findings from a cross-sectional study among formal sector employees in Dodoma City, Central Tanzania

BMC Public Health ◽

10.1186/s12889-020-10142-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mariam John Munyogwa ◽

Kaloli Sayi Ntalima ◽

Secilia Ng’weshemi Kapalata

Keyword(s):

Central Obesity ◽

Simple Random Sampling ◽

Cross Sectional Study ◽

Formal Sector ◽

Cross Sectional Survey ◽

Chi Square ◽

Cross Sectional ◽

Logistic Regression Models ◽

Face To Face ◽

Chi Square Test

Abstract Background Obesity at the workplace has been associated with symptoms of lower self-esteem, increased individual and employer healthcare costs, increased absenteeism and presenteeism and reduced productivity. Therefore, this study was designed to study the prevalence and correlates of central obesity among formal sector employees in Dodoma City. Methods Study design was a cross-sectional survey conducted from March to June, 2019. Participants were employees from formal sector employment defined as those paid regular monthly wage and with either a secured permanent or temporary contract. Simple random sampling was used to select four out of fifteen large buildings hosting various establishments. Respondents were obtained conveniently and interviewed face to face. Central obesity was defined as a waist circumference greater than 102 cm for males and greater than 88 cm for females. Chi-square test was conducted to assess the differences among the groups. Simple and multiple logistic regression models were fitted to identify the correlates of central obesity. Results A total of 392 respondents (98% response rate) agreed and participated in the study. The overall prevalence of central obesity was found to be 41.8% (164/392). The prevalence of central obesity was significantly higher among females (67.4% p < 0.001), respondents aged ≥51 years (60%, p = < 0.001), administrators (55.1% p = < 0.05), respondents with salary of > 1,000,000 Tanzanian Shilling (TSh.) per month (54.4%, p = < 0.05), respondents who eat homemade meals at the workplace (64.2%, p = < 0.05) and respondents with hypertension (62.5%, p = < 0.05). Correlates of central obesity were found to be female sex (AOR = 9.53; 95% CI: 5.49, 16.78), increased age, eating homemade meals at the workplace (AOR = 2.32; 95% CI: 1.04, 4.19) and hypertension (AOR = 3.15; 95% CI: 1.41, 6.91). Conclusions The present study revealed high prevalence of central obesity among formal sector employees in Dodoma City. Scholars and stakeholders are urged to generate more evidences and design appropriate interventions to curb the situation.

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Resuscitation and Withdrawal of Therapy in Pediatric Intensive Care

PEDIATRICS ◽

10.1542/peds.89.5.961 ◽

1992 ◽

Vol 89 (5) ◽

pp. 961-963

Author(s):

RICHARD B. MINK ◽

MURRAY M. POLLACK

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Life Support ◽

Pediatric Intensive Care ◽

New Haven ◽

Hammersmith Hospital ◽

Hospital Deaths ◽

Withdrawal Of Therapy ◽

Haven Hospital

Although issues concerning withdrawal and limitation of life support are commonly discussed,1-6 actual practices in pediatrics are largely unknown and are limited to neonatal intensive care unit (ICU) studies. In the neonatal ICUs at Yale-New Haven Hospital and at Hammersmith Hospital, 14% and 30%, respectively, of all deaths followed withdrawal of care.7,8 In adult ICUs, limitation and/or withdrawal of therapy is common,9 and in one investigation, resuscitation was not attempted immediately before ICU death in nearly two-thirds of cases.10 Nonetheless, many physicians believe that most hospital deaths occur only after all resuscitative attempts have failed,6,11,12 and others believe that resuscitative efforts neither are indicated nor desirable in many cases.1,13

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GUIDANCE IN MATERNAL AND INFANT CARE TWO MONTHS BEFORE AND AFTER THE BIRTH OF THE FIRST-BORN

PEDIATRICS ◽

10.1542/peds.2.2.200 ◽

1948 ◽

Vol 2 (2) ◽

pp. 200-206

Author(s):

AUGUSTA STUART CLAY

Keyword(s):

Normal Growth ◽

Point Of View ◽

High School Education ◽

Pediatric Care ◽

New Haven ◽

Private Physician ◽

Healthy Pregnancy ◽

Before And After ◽

Haven Hospital ◽

Made In

THIS study was made in the belief that family living and growth can be healthier if parents understand how mother and baby develop and what they need. Eleven mothers were visited weekly for two months before and after the birth of their firstborn to discover what guidance they wanted, what was offered, and what additional guidance was needed. The writer secured their cooperation by agreeing to work with them as a consultant, to interpret their point of view to the doctor, to explain medical instructions when permitted, and to teach the normal growth processes of mother and baby. Ten mothers were registered in the prenatal clinics of the New Haven Hospital; the eleventh had a private physician. They had no recorded problems beyond the needs of healthy pregnancy and they wanted to participate. Eight husbands agreed to take part in the study. The other three were overseas, but their wives reported for them. Backgrounds varied; 20 of the 22 had had college or high school education; all were between 18 and 32. None dropped out, and after the four months all asked for continued guidance. Cases were too few and the study too brief for statistical evidence. But problems were uncovered which needed to be considered and which have largely been neglected in routine obstetric and pediatric care. These parents wanted to learn—not in classes, but in the privacy of home—how to care for mother and baby without disrupting their accustomed way of living. All wanted the care and interest of one doctor for mother and one for baby. However, six women and five men preferred to talk with a consultant who was not a doctor, but who was affiliated with their doctors. The doctors seemed too busy for "little things" and "family affairs," and they saw so many doctors that they all seemed strangers. Once they felt sure that the consultant's interest was in themselves rather than in teaching them, they set the pace and pattern in the conference. There was no questionnaire, no probing, no set procedure. If they had any immediate interests or problems: job, move, presents, trips, in-laws, illness—these were discussed before they talked of pregnancy and baby.

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Nutritional concerns of patients enrolled in an outpatient geriatric assessment center

Journal of the American Dietetic Association ◽

10.1016/0002-8223(94)91657-8 ◽

1994 ◽

Vol 94 (9) ◽

pp. A23

Author(s):

M.R Harrity ◽

S Nelson ◽

E Danto-Nocton ◽

L Stanley ◽

C.J Yesner ◽

...

Keyword(s):

Geriatric Assessment ◽

Assessment Center

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Anatomically Correct Dolls Used in Interviews of Young Children Suspected of Having Been Sexually Abused

PEDIATRICS ◽

10.1542/peds.84.5.900 ◽

1989 ◽

Vol 84 (5) ◽

pp. 900-906

Author(s):

John M. Leventhal ◽

Julia Hamilton ◽

Susan Rekedal ◽

Anna Tebano-Micci ◽

Cynthia Eyster

Keyword(s):

Sexual Abuse ◽

Young Children ◽

Sexually Abused ◽

Diagnostic Interview ◽

New Haven ◽

Diagnostic Interviews ◽

Haven Hospital

To determine the value of using anatomically correct dolls in diagnostic interviews of young children suspected of being sexually abused, the records of 83 children who were less than 7 years of age and who were evaluated at Yale-New Haven Hospital because of a suspicion of sexual abuse were reviewed. The dolls were used in 60 cases (72%). When the dolls were used, children provided significantly more information than by interview alone about what had happened and about the identity of the suspected perpetrator. Children less than 3 years of age, however, were unable to provide details about the abuse despite the use of the dolls. The ratings of the likelihood that sexual abuse had occurred were based on all of the information in the case including that obtained through the diagnostic interview with the dolls. When these ratings were compared with the ratings based on evidence obtained solely from noninterview data, the likelihood of abuse was higher in 35% of the cases. It was concluded that substantially more information is provided by young children when anatomically correct dolls are used and that the likelihood of detection of abuse is increased when information from the child is included in the assessment.

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