Facial Trauma During the COVID-19 Pandemic

Study Design Retrospective cohort study. Objective The purpose of this study is to evaluate the impact of the COVID-19 global pandemic on the regional trends in facial trauma at a tertiary care, level 1 trauma center in Central New York. Methods The study sample was derived from the population of patients who presented with facial trauma to the emergency department at the Downtown and/or Community Campuses of SUNY Upstate University Hospital between March 1, 2020, and May 15, 2020, and compared to two historical controls in 2018 and 2019. Descriptive and bivariate statistics were calculated for study variables in each cohort. Poisson regression was used to compare incident rate ratios (IRR) with 95% confidence intervals with significance set at P < .05. Results Sixty five patients presented during the COVID-19 pandemic, while 83 presented in 2019 and 95 in 2018. For the study period, the most common mechanism was assault in 47.7%. IRR was significantly lower than in 2018 (IRR = 1.46, P = .018), but not significantly different from 2019 (IRR = 1.28, P = .14). During lockdown, IRR was significantly decreased compared to 2019 (IRR = 1.84, P = .0029) and 2018 (IRR = 2.16, P < .001). Conclusion The volume of facial trauma seen in Central New York appears undeterred in the absence of “shelter in place” orders. Analysis of pandemic and regional trauma variations can offer valuable insight for improved resource allocation to better prepare for potentially high-risk procedures.

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Determining the Impact of the Opioid Crisis on a Tertiary-Care Hospital in Central New York to Identify Critical Areas of Intervention in the Local Community

Journal of Addiction ◽

10.1155/2020/3956187 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Sanjay K. Yadava ◽

Stephen J. Thomas ◽

Scott Riddell ◽

Dongliang Wang ◽

Timothy P. Endy

Keyword(s):

New York ◽

Hospital Admissions ◽

Tertiary Care ◽

Case Fatality ◽

Hospitalized Patients ◽

Care Hospital ◽

Opioid Use ◽

Medical Reason ◽

Central New York ◽

The Impact

Background. Central New York has been afflicted by the heroin epidemic with an increase in overdose deaths involving opioids. Objective. The objective of the study was to understand the epidemiology of hospitalizations related to a diagnosis of opioid use (OU). Design. The study was designed as a retrospective analysis of hospitalized patients admitted from January 1, 2008, to December 30, 2018, using ICD-9 and 10 codes for heroin or opiate use, overdose, or poisoning. Setting. The study was conducted in a tertiary-care and teaching hospital located in Central New York. Patients. Hospitalized patients were included as study participants. Results. Opioid use-related admissions increased from .05/100 hospital admissions in 2008 to a peak of 2.9/100 in 2018, a 58-fold increase. There were 49 deaths over the 11-year period for an overall case fatality of 1.2 per 100 OU admissions. The median age for all years was 40 years (SD of 13.7 years), and admissions were largely white caucasians (67.0% of all admissions). The mean length of stay was 8.55 days (SD 12 days), with a range of 1 to 153 days. The most frequent discharge diagnosis was due to infections (15.0% of discharge diagnoses) followed by trauma (5.8% of discharge diagnoses). Methicillin-resistant Staphylococcus aureus was more common in patients with OU (58.1%) than in patients with non-OU (43%) (p<0.0001 by chi-square with Yates’ correction). Spatial analysis was performed by zip code and demonstrated regional hotspots for OU-related admissions. Limitations. The limitations of this study are its retrospective nature and largely numerator-based analysis. The use of ICD codes underrepresents the true burden due to underreporting and failure to code appropriately. This study focuses on patients who are hospitalized for a medical reason with a secondary diagnosis of opioid use and does not include patients who present to the emergency room with an overdose underrepresenting the true burden of the problem. Conclusions. Our results demonstrate the impact of the opioid epidemic in one tertiary-care center and the need to prepare for the costs and resources to address addiction care for this population.

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Randomized Prospective Study of the Impact of Three Needleless Intravenous Systems on Needlestick Injury Rates

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700003544 ◽

1996 ◽

Vol 17 (12) ◽

pp. 803-808

Author(s):

Paul B. L'Ecuyer ◽

Elizabeth Owens Schwab ◽

Elizabeth Iademarco ◽

Norma Barr ◽

Elizabeth A. Aton ◽

...

Keyword(s):

Controlled Trial ◽

Tertiary Care ◽

Control Area ◽

Needlestick Injury ◽

Pathogen Transmission ◽

Needlestick Injuries ◽

Injury Rates ◽

Rate Ratios ◽

And Control ◽

The Impact

AbstractObjective:To determine the impact of three needleless intravenous systems on needlestick injury rates.Design:Randomized controlled trial.Setting:1,000-bed tertiary-care Midwestern hospital.Participants:Nursing personnel from general medical, general surgical, and intensive-care units.Interventions:From June 1992 through March 1994, a metal blunt cannula (MBC), two-way valve (2-way), and plastic blunt cannula (PBC) were introduced into three study areas, and needlestick injury rates were compared to three control areas using traditional needled devices.Results:24 and 29 needlestick injuries were reported in study and control areas. Intravenous-therapy-related injuries comprised 45.8% and 57.1% of injuries in each area. Thirty-seven percent and 20.7% of study and control area needlestick injuries were considered to pose a high risk of bloodborne infection. The 2-way group had similar rates of total and intravenous-related needlestick injuries compared to control groups. The PBC group had lower rates of total and intravenous-related needlestick injuries per 1,000 patient-days (rate ratios [RR], 0.32 and 0.24; 95°% confidence intervals [CI95], 0.12-0.81 and 0.09-0.61;P=.02 andP=.003, respectively) and per 1,000 productive hours worked (RR, 0.11 and 0.08; CI95, 0.01-0.92 and 0.010.69;P=.03 andP=.005, respectively) compared to controls.Conclusions:Needlestick injuries continued in study areas despite the introduction of needleless devices, and risks of bloodborne pathogen transmission were similar to control areas. The PBC device group noted lower rates of needlestick injuries compared to controls, but there were problems with product acceptance, correct product use, and continued traditional device use in study areas. Low needlestick injury rates make interpretations difficult. Further studies of safety devices are needed and should attempt greater control of worker behavior to aid interpretation.

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Advancing Pediatric Palliative Care In a Low-Middle Income Country: An Implementation Study, A challenging but not impossible task

10.21203/rs.3.rs-39336/v3 ◽

2020 ◽

Author(s):

Ximena Garcia-Quintero ◽

Luis Gabriel Parra-Lara ◽

Angelica Claros-Hulbert ◽

Maria Isabel Cuervo-Suarez ◽

Wendy Gomez-Garcia ◽

...

Keyword(s):

Palliative Care ◽

Service Providers ◽

Pediatric Population ◽

Descriptive Analysis ◽

Tertiary Care ◽

Care Program ◽

University Hospital ◽

Pediatric Palliative Care ◽

Middle Income ◽

The Impact

Abstract Background: The disparities in access to pediatric palliative care and pain management in Latin America remains an unaddressed global health issue. Efforts to improve the development of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Care (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program, “Taking Care of You ” (TCY) , in a tertiary care, university hospital in Cali, Colombia. Methods: A program’s database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis was carried out to evaluate the impact of the program and service delivery. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis. Results: Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of ambulatory patients increased by 80% every trimester between 2017-2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period. Conclusions: The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a PPC program and how the referral times, coordination of care, communication with other hospital services were improved while providing compassionate/holistic care to children with life-limiting and threatening diseases and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.

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Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations

Journal of Oncology Practice ◽

10.1200/jop.2017.025684 ◽

2018 ◽

Vol 14 (1) ◽

pp. e42-e50 ◽

Cited By ~ 9

Author(s):

Andrew P. Loehrer ◽

David C. Chang ◽

Zirui Song ◽

George J. Chang

Keyword(s):

New York ◽

Private Insurance ◽

Insurance Coverage ◽

High Volume ◽

Percentage Point Increase ◽

Point Increase ◽

Coverage Expansion ◽

Incident Rate ◽

And Control ◽

The Impact

Purpose: Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. Methods: Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework. Results: We studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals ( P < .001). Conclusion: The 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.

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Prevalence and Overtesting of True Heparin-Induced Thrombocytopenia in a 591-Bed Tertiary Care, Teaching Hospital

Journal of Intensive Care Medicine ◽

10.1177/0885066617722707 ◽

2017 ◽

Vol 34 (6) ◽

pp. 464-471 ◽

Cited By ~ 4

Author(s):

Stephen Farley ◽

Caitlyn Cummings ◽

William Heuser ◽

Shan Wang ◽

Rose Calixte ◽

...

Keyword(s):

New York ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Elisa Test ◽

Serotonin Release ◽

University Hospital ◽

Enzyme Linked Immunosorbent Assay ◽

Heparin Induced Thrombocytopenia ◽

Release Assay ◽

Hospital Stays

Heparin-induced thrombocytopenia type II (HIT) is a rare but potentially fatal antibody-mediated reaction to all forms of heparin (unfractionated heparin, low-molecular weight heparin, heparin flushes, and heparin-coated catheters), which can lead to HIT with thrombosis. Two tests commonly used to screen for HIT include the enzyme-linked immunosorbent assay (ELISA) and serotonin release assay (SRA). This is a retrospective chart review study conducted from January 1, 2013, through December 31, 2014, to estimate the rate of true HIT in critical care patients at Winthrop-University Hospital, located in Mineola, New York. Patients are classified as positive for HIT if both ELISA and SRA immunoassays are positive. We reviewed 507 heparin immunoassays, excluding 64 who had an inappropriate ELISA test sent due to no administration of heparin, enoxaparin, or heparin lock flush at this or previous hospital stays at Winthrop. Of the 443 heparin immunoassays, ELISA results were positive for 66 patients (15.1%), and only 11 (2.5%) patients had true cases of HIT with a 95% confidence interval of 1.3% to 4.4%. The 4T score for those with true HIT (median: 5.0) was statistically higher compared to those without true HIT (median: 2.0; P < .001). Despite guidelines in place, overtesting for HIT is still a prevalent issue.

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127. walking to the Virtual Era. Analysis of the Telehealth Experience in the Infectious Diseases Clinic During the COVID Pandemic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.437 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S193-S193

Author(s):

Karen L Carvajal ◽

Prishanya Pillai ◽

Angelina Winbush ◽

Rupinder mangat ◽

Ted Louie

Keyword(s):

New York ◽

Infectious Diseases ◽

Medical Center ◽

Compliance Rate ◽

Tertiary Care ◽

Clinic Visit ◽

P Value ◽

Hiv Patients ◽

The Impact

Abstract Background The COVID pandemic has changed and will continue changing the way we practice medicine. We sought to investigate the impact of telehealth (TH) in the delivery of healthcare in the general infectious diseases (GID), and HIV clinic during the COVID pandemic. The University of Rochester Medical Center is a major tertiary care and referral center for ID in upstate New York. From March through May of 2020, the clinics were closed, and nearly all visits were conducted by TH. Methods We surveyed (either by telephone or online) a total of 260 patients who participated in TH visits, with a mean age of 56 years in the HIV group and 59 years in the GID group. With a predominance of 62.8 of males v/s 37.2 of females. We collected information regarding the reason for the TH visits, access to technology, patient satisfaction, and preferences over in-person visits. We obtained the volume and no-show rate from prior years through EPIC. We evaluated compliance between in-person and TH visits using statistical analysis. Results We found 93.4% of GID and 84.3% of HIV patients surveyed, either strongly agreed or somewhat agreed that their TH visit was as satisfactory as a clinic visit. 67.5% of GID and 63% of HIV patients agreed that the option of TH would increase their compliance rate in the future. The no-show rate during the TH period in the HIV group decreased from 23% to 5% compared to the previous year, while the no-show rate in GID decreased from 9% to 4%. These results were statistically significant with a P-value < 0.005 in both groups. Conclusion GID patients were more likely to have TH for hospital follow-up, follow-up of acute problems, and outpatient antibiotic therapy, compared to HIV patients, who more often had TH for chronic problems. GID patients were more likely to have the capability for televideo visits when compared to the HIV group, although this was not statistically significant. TH was statistically significant in improving patient compliance with appointments in both the HIV and ID clinics. Patients were overall highly satisfied with their TH experience and many patients also reported that continued availability of telemedicine would improve their compliance with appointments. Disclosures All Authors: No reported disclosures

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Advancing Pediatric Palliative Care In A Low-Middle Income Country: A Descriptive Analysis of the Implementation, A challenging But Not Impossible Task

10.21203/rs.3.rs-39336/v1 ◽

2020 ◽

Author(s):

Ximena Garcia-Quintero ◽

Luis Gabriel Parra-Lara ◽

Angelica Claros-Hulbert ◽

Maria Isabel Cuervo-Suarez ◽

Wendy Gomez-Garcia ◽

...

Keyword(s):

Palliative Care ◽

Service Providers ◽

Pediatric Population ◽

Descriptive Analysis ◽

Tertiary Care ◽

Care Program ◽

University Hospital ◽

Pediatric Palliative Care ◽

Middle Income ◽

The Impact

Abstract Background: The abyss of access to palliative care and pain management in Latin America remains to be an unaddressed global health issue. Efforts to improve the development level of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Cares (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program “Taking Care of You” (TCY), in a tertiary care university hospital in Cali, Colombia. Methods: A program’s database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis to evaluate the impact of the program and service delivery was conducted. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis. Results: Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of outpatients increased by 80% every trimester between 2017-2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period. Conclusions: The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a program, and how the referral times, coordination of care, communication with other hospital services were improved. Providing compassionate/holistic care to children with Life-limiting and threatening diseases, and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.

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Advancing Pediatric Palliative Care In a Low-Middle Income Country: An Implementation Study, A challenging but not impossible task

10.21203/rs.3.rs-39336/v2 ◽

2020 ◽

Author(s):

Ximena Garcia-Quintero ◽

Luis Gabriel Parra-Lara ◽

Angelica Claros-Hulbert ◽

Maria Isabel Cuervo-Suarez ◽

Wendy Gomez-Garcia ◽

...

Keyword(s):

Palliative Care ◽

Service Providers ◽

Pediatric Population ◽

Descriptive Analysis ◽

Tertiary Care ◽

Care Program ◽

University Hospital ◽

Pediatric Palliative Care ◽

Middle Income ◽

The Impact

Abstract Background: The abyss of access to pediatric palliative care and pain management in Latin America remains to be an unaddressed global health issue. Efforts to improve the development level of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Cares (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program “Taking Care of You ” (TCY) , in a tertiary care university hospital in Cali, Colombia. Methods: A program’s database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis to evaluate the impact of the program and service delivery was conducted. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis. Results: Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of outpatients increased by 80% every trimester between 2017-2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period. Conclusions: The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a program, and how the referral times, coordination of care, communication with other hospital services were improved. Providing compassionate/holistic care to children with Life-limiting and threatening diseases, and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.

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Hand Hygiene, and Not Ertapenem Use, Contributed to Reduction of Carbapenem-Resistant Pseudomonas aeruginosa Rates

Infection Control and Hospital Epidemiology ◽

10.1086/660100 ◽

2011 ◽

Vol 32 (6) ◽

pp. 584-590 ◽

Cited By ~ 17

Author(s):

Rodrigo Pires dos Santos ◽

Thalita Jacoby ◽

Denise Pires Machado ◽

Thiago Lisboa ◽

Sandra Ludwig Gastal ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Regression Analysis ◽

Tertiary Care ◽

Carbapenem Resistance ◽

University Hospital ◽

Incidence Density ◽

Level Change ◽

Carbapenem Resistant ◽

Defined Daily Doses ◽

The Impact

Objective.To evaluate the impact of ertapenem use in Pseudomonas aeruginosa carbapenem resistance, taking into account the volume of antimicrobial consumption, the consumption by the entire hospital of alcohol-based antiseptic hand rub, and the density rate of invasive practices.Design.Before-and-after trial.Setting.A tertiary care university hospital in southern Brazil.Methods.Ertapenem was first added to the hospital formulary in June 2006, and it was excluded in February 2009. We evaluated Pseudomonas aeruginosa resistance rates through 3 study periods: period 1, before ertapenem use (17 months); period 2, during ertapenem use (33 months); and period 3, after exclusion of ertapenem (15 months).Results.After introduction of ertapenem, there was a significant decrease in median consumption of imipenem or meropenem, from 2.6 to 2.2 defined daily doses (DDDs) per 100 patient-days (level change from 0.04 to -1.08; P < .01), and an increase in the use of these medications after ertapenem exclusion, from 2.2 to 3.3 DDDs per 100 patient-days (level change from -0.14 to 0.91; P < .01), by segmented regression analysis. There was no difference in the incidence density of carbapenem-resistant P. aeruginosa infection related to ertapenem use throughout the study periods. However, by multiple regression analysis, the reduction in the rate of carbapenem-resistant P. aeruginosa infection correlated significantly with the increase in the volume of alcohol used as hand sanitizer, which was from 660.7 mL per 100 patient-days in period 1 to 2,955.1 mL per 100 patient-days in period 3 (P = .04). Ertapenem use did not impact the rate of carbapenem-resistant P. aeruginosa infection.Conclusions.Use of alcohol-based hand gel, rather than ertapenem, was associated with a reduction in the rates of carbapenem-resistant P. aeruginosa infection. Measures to reduce resistance must include factors other than just antimicrobial stewardship programs alone.

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Advancing pediatric palliative care in a low-middle income country: an implementation study, a challenging but not impossible task

BMC Palliative Care ◽

10.1186/s12904-020-00674-2 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ximena Garcia-Quintero ◽

Luis Gabriel Parra-Lara ◽

Angelica Claros-Hulbert ◽

Maria Isabel Cuervo-Suarez ◽

Wendy Gomez-Garcia ◽

...

Keyword(s):

Palliative Care ◽

Service Providers ◽

Pediatric Population ◽

Descriptive Analysis ◽

Tertiary Care ◽

Care Program ◽

University Hospital ◽

Pediatric Palliative Care ◽

Middle Income ◽

The Impact

Abstract Background The disparities in access to pediatric palliative care and pain management in Latin America remains an unaddressed global health issue. Efforts to improve the development of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Care (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program, “Taking Care of You” (TCY), in a tertiary care, university hospital in Cali, Colombia. Methods A program’s database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis was carried out to evaluate the impact of the program and service delivery. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis. Results Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of ambulatory patients increased by 80% every trimester between 2017 and 2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period. Conclusions The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a PPC program and how the referral times, coordination of care, communication with other hospital services were improved while providing compassionate/holistic care to children with life-limiting and threatening diseases and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.

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