scholarly journals Evolving oxygenation management reasoning in COVID-19

Diagnosis ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 381-383
Author(s):  
Steven Liu ◽  
Cara Sweeney ◽  
Nalinee Srisarajivakul-Klein ◽  
Amanda Klinger ◽  
Irina Dimitrova ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Initial Phase ◽  
The United States ◽  
Lessons Learned ◽  
Hypoxemic Respiratory Failure ◽  
Hospital Wards

AbstractThe initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

scholarly journals Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

Kidney360 ◽  
2020 ◽  
Vol 1 (12) ◽  
pp. 1345-1352
Author(s):  
Nina J. Caplin ◽  
Olga Zhdanova ◽  
Manish Tandon ◽  
Nathan Thompson ◽  
Dhwanil Patel ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Peritoneal Dialysis ◽  
York City ◽  
The United States ◽  
Public Hospitals ◽  
Bellevue Hospital

BackgroundThe COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. New York University Medical Center and affiliations, including New York City Health and Hospitals/Bellevue, developed a plan to offset the increased needs for KRT. We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 AKI.MethodsObservational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the United States, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Adult patients admitted with AKI who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous venovenous hemofiltration for treating patients in the intensive–care unit, demonstrating efficacy with outcomes comparable to standard care.ResultsFrom April 8, 2020 to May 8, 2020, 39 catheters were placed into ten women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 years for men and 59.5 years for women); men and women who expired were an average 71.8 and 66.2 years old. No episodes of peritonitis were observed; there were nine incidents of minor leaking. Some patients were treated while ventilated in the prone position.ConclusionsDemand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing dialysis treatments in health crises.

scholarly journals COVID-19-Associated Critical Illness—Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center

2020 ◽  
Vol 35 (10) ◽  
pp. 963-970 ◽  
Author(s):  
Sudham Chand ◽  
Sumit Kapoor ◽  
Deborah Orsi ◽  
Melissa J. Fazzari ◽  
Tristan G. Tanner ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Intensive Care ◽  
Critical Illness ◽  
Mortality Rate ◽  
York City ◽  
Medical Center ◽  
The United States

Background: The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States. Methods: We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up. Results: Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized. Conclusions: Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations.

Applying the Devil's Works in a Holy Cause: Working-Class Popular Culture and the Salvation Army in the United States, 1879-1900

1997 ◽  
Vol 7 (2) ◽  
pp. 195-223
Author(s):  
Lillian Taiz
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
Popular Culture ◽  
York City ◽  
The United States ◽  
Salvation Army ◽  
Public Meeting ◽  
The Many ◽  
Sunday Evening

Forty-eight hours after they landed in New York City in 1880, a small contingent of the Salvation Army held their first public meeting at the infamous Harry Hill's Variety Theater. The enterprising Hill, alerted to the group's arrival from Britain by newspaper reports, contacted their leader, Commissioner George Scott Railton, and offered to pay the group to “do a turn” for “an hour or two on … Sunday evening.” In nineteenth-century New York City, Harry Hill's was one of the best known concert saloons, and reformers considered him “among the disreputable classes” of that city. His saloon, they said, was “nothing more than one of the many gates to hell.”

scholarly journals The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

2021 ◽  
pp. 1-15
Author(s):  
Kevin Hauck ◽  
Katherine Hochman ◽  
Mark Pochapin ◽  
Sondra Zabar ◽  
Jeffrey A Wilhite ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Medical Center ◽  
The United States ◽  
Lessons Learned ◽  
Front Line ◽  
Clinical Leadership ◽  
Team Members ◽  
Medical Centers ◽  
Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

scholarly journals Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

2021 ◽  
pp. 1-6
Author(s):  
Diane Meyer ◽  
Elena K. Martin ◽  
Syra Madad ◽  
Priya Dhagat ◽  
Jennifer B. Nuzzo
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
The United States ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

Values of Voluntary Simplicity: Lifestyle and Motivation

1984 ◽  
Vol 55 (1) ◽  
pp. 231-240 ◽  
Author(s):  
Avraham Shama ◽  
Joseph Wisenblit
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
York City ◽  
Metropolitan Areas ◽  
The United States ◽  
Voluntary Simplicity ◽  
Ecological Responsibility ◽  
Self Sufficiency ◽  
And Behavior

This paper describes the relation between values and behavior of a new life style, that of voluntary simplicity which is characterized by low consumption, self-sufficiency, and ecological responsibility. Also, specific hypotheses regarding the motivation for voluntary simplicity and adoption in two areas of the United States were tested. Analysis shows (a) values of voluntary simplicity and behaviors are consistent, (b) the motivation for voluntary simplicity includes personal preference and economic hardship, and (c) adoption of voluntary simplicity is different in the Denver and New York City metropolitan areas.

Do Stock Markets Catch the Flu?

2013 ◽  
Vol 48 (3) ◽  
pp. 979-1000 ◽  
Author(s):  
Brian C. McTier ◽  
Yiuman Tse ◽  
John K. Wald
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
Stock Markets ◽  
The United States ◽  
Trading Activity ◽  
Market Makers ◽  
International Data ◽  
The Impact ◽  
Bid Ask Spreads

AbstractWe examine the impact of influenza on stock markets. For the United States, a higher incidence of flu is associated with decreased trading, decreased volatility, decreased returns, and higher bid-ask spreads. Consistent with the flu affecting institutional investors and market makers, the decrease in trading activity and volatility is primarily driven by the incidence of influenza in the greater New York City area. However, the effect of the flu on bid-ask spreads and returns is related to the incidence of flu nationally. International data confirm our findings of a decrease in trading activity and returns when flu incidence is high.

scholarly journals Healthcare-Associated Infections among Patients in a Large Burn Intensive Care Unit: Incidence and Pathogens, 2008–2012

2014 ◽  
Vol 35 (10) ◽  
pp. 1304-1306 ◽  
Author(s):  
David J. Weber ◽  
David van Duin ◽  
Lauren M. DiBiase ◽  
Charles Scott Hultman ◽  
Samuel W. Jones ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
The United States ◽  
Burn Injuries ◽  
Morbidity And Mortality ◽  
Common Source ◽  
Healthcare Associated Infections ◽  
Burn Patients ◽  
Healthcare Associated

Burn injuries are a common source of morbidity and mortality in the United States, with an estimated 450,000 burn injuries requiring medical treatment, 40,000 requiring hospitalization, and 3,400 deaths from burns annually in the United States. Patients with severe burns are at high risk for local and systemic infections. Furthermore, burn patients are immunosuppressed, as thermal injury results in less phagocytic activity and lymphokine production by macrophages. In recent years, multidrug-resistant (MDR) pathogens have become major contributors to morbidity and mortality in burn patients.Since only limited data are available on the incidence of both device- and nondevice-associated healthcare-associated infections (HAIs) in burn patients, we undertook this retrospective cohort analysis of patients admitted to our burn intensive care unit (ICU) from 2008 to 2012.

Cardiovascular Disease Risk Factors Among Immigrant and US-Born Adults in New York City

2021 ◽  
pp. 003335492110075
Author(s):  
Claudia Chernov ◽  
Lisa Wang ◽  
Lorna E. Thorpe ◽  
Nadia Islam ◽  
Amy Freeman ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
New York ◽  
New York City ◽  
Health Insurance ◽  
York City ◽  
The United States ◽  
Nutrition Examination Survey ◽  
Health And Nutrition

Objectives Immigrant adults tend to have better health than native-born adults despite lower incomes, but the health advantage decreases with length of residence. To determine whether immigrant adults have a health advantage over US-born adults in New York City, we compared cardiovascular disease (CVD) risk factors among both groups. Methods Using data from the New York City Health and Nutrition Examination Survey 2013-2014, we assessed health insurance coverage, health behaviors, and health conditions, comparing adults ages ≥20 born in the 50 states or the District of Columbia (US-born) with adults born in a US territory or outside the United States (immigrants, following the National Health and Nutrition Examination Survey) and comparing US-born adults with (1) adults who immigrated recently (≤10 years) and (2) adults who immigrated earlier (>10 years). Results For immigrant adults, the mean time since arrival in the United States was 21.8 years. Immigrant adults were significantly more likely than US-born adults to lack health insurance (22% vs 12%), report fair or poor health (26% vs 17%), have hypertension (30% vs 23%), and have diabetes (20% vs 11%) but significantly less likely to smoke (18% vs 27%) (all P < .05). Comparable proportions of immigrant adults and US-born adults were overweight or obese (67% vs 63%) and reported CVD (both 7%). Immigrant adults who arrived recently were less likely than immigrant adults who arrived earlier to have diabetes or high cholesterol but did not differ overall from US-born adults. Conclusions Our findings may help guide prevention programs and policy efforts to ensure that immigrant adults remain healthy.

Stylistic variation among mobile speakers: Using old and new regional variables to construct complex place identity

2018 ◽  
Vol 30 (2) ◽  
pp. 175-202 ◽  
Author(s):  
Jennifer Nycz
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
Positive Affect ◽  
York City ◽  
The United States ◽  
Place Identity ◽  
Washington Dc ◽  
Stylistic Variation ◽  
Show Evidence

AbstractThis paper examines stylistic variation in the (oh), (o), (aw), and (ay) classes among native speakers of Canadian English living in or just outside either New York City or Washington, DC. Speakers show evidence of change toward US norms for all four vowels, though only (aw) shows consistent style shifting: prevoiceless (aw) is realized with higher nuclei when speakers express ambivalence about or distance from the United States, and lower nuclei when closeness to or positive affect about the United States is being conveyed. Canadians in New York also show topic- and stance-based shift in (oh): (oh)s are higher when expressing positive affect or closeness to New York City and lower when expressing negative affect or distance. These results suggest that mobile speakers continue to exploit the socioindexical links in their native dialect while learning and using new links in their adopted dialect—but only if those links are socially salient.

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