scholarly journals Microsurgical education in the USA: Past, present and future

2021 ◽  
Vol 24 (1) ◽  
pp. 9-18
Author(s):  
K. H. Park ◽  
G. Romero ◽  
J. Paladino ◽  
J. Daou ◽  
Y. Akelina
Keyword(s):  
New York ◽  
Training Programs ◽  
Medical Center ◽  
Training Curriculum ◽  
Repeated Practice ◽  
Student Progression ◽  
Adequate Education ◽  
Structural Differences ◽  
The Usa ◽  
Attention To Detail

Microsurgery is a demanding surgical skillset which requires attention to detail and repeated practice to succeed. Microsurgery courses around the globe allow students to learn through performing a variety of technical exercises. Microsurgery education dates back to the late 1960s with notable instructors, Harry J. Buncke and Robert Acland. Currently, many microsurgery courses are available that share commonalities, and some important structural differences have been demonstrated to differentially affect student progression and competence. Multiple available training programs as well as the advancement of supermicrosurgery training is listed and described.The microsurgery training course at Columbia University’s New York Presbyterian Irving Medical Center led by Drs. Ronsenwasser, Strauch and Akelina provides students with expert instruction through a punctilious training curriculum. By imparting these techniques to the students, trainees’s progression markedly improves relative to alternative microsurgery courses that do not incorporate expert instruction. The Covid-19 pandemic, has resulted in the development of a virtual microsurgery training program at the lab which focuses on building the foundation of basic skills for trainees unable to travel or receive adequate education.

History and evolution of regional anesthesiology and acute pain medicine fellowship training

2020 ◽  
Vol 45 (4) ◽  
pp. 311-314 ◽  
Author(s):  
David Michael Shapiro ◽  
Mary J Hargett ◽  
Sandra Kopp ◽  
Joseph M Neal ◽  
Edward R Mariano ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Acute Pain ◽  
Training Programs ◽  
Medical Center ◽  
Fellowship Training ◽  
Specific Information ◽  
Subspecialty Training ◽  
Pain Medicine ◽  
Current State ◽  
The Usa

IntroductionIn 2016, individual training programs in regional anesthesiology and acute pain medicine (RA/APM) became eligible for accreditation by the Accreditation Council for Graduate Medical Education (ACGME), thereby culminating a process that began 15 years earlier. Herein, we review the origins of regional anesthesia training in the USA, the events leading up to accreditation and the current state of the fellowship.MethodsWe reviewed pertinent literature on the historical aspects of RA/APM in the USA, related subspecialty training and the formation and current state of RA/APM fellowship training programs. Additionally, a survey was distributed to the directors of the 74 RA/APM fellowships that existed as of 1 January 2017 to gather up-to-date, program-specific information.ResultsThe survey yielded a 76% response rate. Mayo Clinic Rochester and Virginia Mason Medical Center likely had the first structured RA/APM fellowships with formalized curriculums and stated objectives, both starting in 1982. Most programs (86%), including ACGME and non-ACGME fellowships, came into existence after the year 2000. Six responding programs have or previously had RA/APM comingled with another subspecialty. Eight current programs originally offered unofficial or part-time fellowships in RA/APM, with fellows also practicing as attending physicians.DiscussionThe history of RA/APM training in the USA is a tortuous one. It began with short ‘apprenticeships’ under the tutelage of the early proponents of regional anesthesia and continues today with 84 official RA/APM programs and a robust fellowship directors’ group. RA/APM programs teach skills essential to the practice and improvement of anesthesiology as a specialty.

scholarly journals Incidence of Norovirus-Associated Acute Gastroenteritis in Four Veteran’s Affairs Medical Center Populations in the United States, 2011–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S317-S317
Author(s):  
Scott Grytdal ◽  
Hannah Browne ◽  
Nikail Collins ◽  
Blanca Vargas ◽  
Maria Rodriguez-Barradas ◽  
...  
Keyword(s):  
New York ◽  
Los Angeles ◽  
Acute Gastroenteritis ◽  
Medical Center ◽  
Diagnostic Testing ◽  
The United States ◽  
Outpatient Visits ◽  
Annual Range ◽  
The Usa ◽  
Stool Specimens

Abstract Background In the USA, norovirus is an important cause of epidemic acute gastroenteritis (AGE) as well as a leading cause of pediatric AGE. However, the burden of sporadic norovirus disease in US adults has not been well-documented. Our objective was to estimate the incidence of outpatient visits and hospitalizations for community-acquired norovirus AGE at four Veterans Affairs Medical Centers (VAMCs) and their associated outpatient clinics in Atlanta, GA; Bronx, New York; Houston, TX; and Los Angeles, CA. Methods From November 2011 to September 2015, stool specimens collected for clinician-requested diagnostic testing within 7 days of AGE symptom onset and with reported vomiting or diarrhea were tested for norovirus by real-time RT-PCR and positive samples were genotyped by Sanger sequencing. Incidence of norovirus-associated outpatient visits and hospitalizations were calculated by multiplying the prevalence of norovirus among tested specimens by AGE-coded outpatient encounters and inpatient discharges, and dividing by the unique patients served at each VAMC. Results 1,620 stool specimens were tested from all 4 sites. Seven percent of outpatient (n = 795) samples (annual range: 3%–10%; range by site: 3%–10%) and 6% of
(n = 825) samples from hospitalized patients tested positive for norovirus (annual range: 3%–8%; range by site: 3%–10%). Forty-four percent of norovirus-positive specimens were typed as GII.4 Sydney. Seventy-four percent of norovirus-positive specimens were collected between November and April. From 2011 to 2015, outpatient norovirus incidence was 250/100,000 population (annual range: 129 to 426/100,000; range by site: 87 to 428/100,000), and the incidence of norovirus hospitalizations was 28/100,000 population (annual range: 19 to 39/100,000; range by site: 14 to 57/100,000). By age group and setting, the highest incidence was observed among 45- to 64-year-old outpatients (370/100,000 population), and 85+-year-old inpatients (63/100,000 population). Conclusion This study provides estimates of the incidence of norovirus AGE outpatient visits and hospitalizations across multiple years among a geographically distributed VA population, highlighting the substantial burden of norovirus in US adults. Disclosures All authors: No reported disclosures.

The New York Adequacy Study: "Determining the Cost of Providing All Children in New York an Adequate Education": Volume 1: Final Report

2004 ◽  
Author(s):  
Jay G. Chambers ◽  
Thomas B. Parrish ◽  
Jesse D. Levin ◽  
James R. Smith ◽  
James W. Guthrie ◽  
...  
Keyword(s):  
New York ◽  
Final Report ◽  
Adequate Education ◽  
The Cost

9/11 and Armageddon: the Christian Right and George W. Bush

2003 ◽  
Vol 2 (1) ◽  
pp. 33-50
Author(s):  
Göran Gunner
Keyword(s):  
New York ◽  
Christian Right ◽  
Political Life ◽  
Religious Leader ◽  
The European Union ◽  
The World ◽  
Mega Church ◽  
The Usa ◽  
Jerry Falwell ◽  
High Degree

Authors from the Christian Right in the USA situate the September 11 attack on New York and Washington within God's intentions to bring America into the divine schedule for the end of the world. This is true of Pat Robertson and Jerry Falwell, and other leading figures in the ‘Christian Coalition’. This article analyses how Christian fundamentalists assess the roles of the USA, the State of Israel, Islam, Iraq, the European Union and Russia within what they perceive to be the divine plan for the future of the world, especially against the background of ‘9/11’. It argues that the ideas of the Christian Right and of President George W. Bush coalesce to a high degree. Whereas before 9/11 many American mega-church preachers had aspirations to direct political life, after the events of that day the President assumes some of the roles of a mega-religious leader.

scholarly journals COVID-19 in obstetrics 2020: the experience at a New York City medical center

2020 ◽  
Vol 48 (9) ◽  
pp. 892-899
Author(s):  
Ashlesha K. Dayal ◽  
Armin S. Razavi ◽  
Amir K. Jaffer ◽  
Nishant Prasad ◽  
Daniel W. Skupski
Keyword(s):  
New York ◽  
Medical Center ◽  
Severe Disease ◽  
Infection Rates ◽  
Health Crisis ◽  
The Public ◽  
Public Health Crisis ◽  
Asymptomatic Carriage ◽  
Global Spread ◽  
Workforce Flexibility

AbstractThe global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.

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 Effect of Environmental Pollutants PM2.5, CO, NO2, and O3 on the Incidence and Mortality of SARS-CoV-2 Infection in Five Regions of the USA

2021 ◽  
Vol 18 (15) ◽  
pp. 7810
Author(s):  
Sultan Ayoub Meo ◽  
Abdulelah Adnan Abukhalaf ◽  
Omar Mohammed Alessa ◽  
Abdulrahman Saad Alarifi ◽  
Waqas Sami ◽  
...  
Keyword(s):  
New York ◽  
New Mexico ◽  
Los Angeles ◽  
Environmental Pollution ◽  
Environmental Pollutants ◽  
Daily Basis ◽  
First Case ◽  
Incidence And Mortality ◽  
Unit Increase ◽  
The Usa

In recent decades, environmental pollution has become a significant international public problem in developing and developed nations. Various regions of the USA are experiencing illnesses related to environmental pollution. This study aims to investigate the association of four environmental pollutants, including particulate matter (PM2.5), carbon monoxide (CO), Nitrogen dioxide (NO2), and Ozone (O3), with daily cases and deaths resulting from SARS-CoV-2 infection in five regions of the USA, Los Angeles, New Mexico, New York, Ohio, and Florida. The daily basis concentrations of PM2.5, CO, NO2, and O3 were documented from two metrological websites. Data were obtained from the date of the appearance of the first case of (SARS-CoV-2) in the five regions of the USA from 13 March to 31 December 2020. Regionally (Los Angeles, New Mexico, New York, Ohio, and Florida), the number of cases and deaths increased significantly along with increasing levels of PM2.5, CO, NO2 and O3 (p < 0.05), respectively. The Poisson regression results further depicted that, for each 1 unit increase in PM2.5, CO, NO2 and O3 levels, the number of SARS-CoV-2 infections significantly increased by 0.1%, 14.8%, 1.1%, and 0.1%, respectively; for each 1 unit increase in CO, NO2, and O3 levels, the number of deaths significantly increased by 4.2%, 3.4%, and 1.5%, respectively. These empirical estimates demonstrate an association between the environmental pollutants PM2.5, CO, NO2, and O3 and SARS-CoV-2 infections, showing that they contribute to the incidence of daily cases and daily deaths in the five different regions of the USA. These findings can inform health policy decisions about combatting the COVID-19 pandemic outbreak in these USA regions and internationally by supporting a reduction in environmental pollution.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P &lt; .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (&gt;60U/L; 39.0% versus 5.9%, P &lt; .001) and aspartate (&gt;40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation &lt;90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P &lt; .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals Leveraging Local Expertise in Stewardship, Hospital Epidemiology and Public Health to Enrich Postgraduate Training in NYC

2020 ◽  
Vol 41 (S1) ◽  
pp. s311-s312
Author(s):  
Kelsie Cowman ◽  
Belinda Ostrowsky ◽  
Susan Seo ◽  
Victor Chen ◽  
Rachel Bartash ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
Case Studies ◽  
Postgraduate Training ◽  
Medical Center ◽  
Effective Means ◽  
Emerging Pathogens ◽  
Hospital Epidemiology ◽  
Full Day ◽  
Epidemiology And Public Health

Background: New York City is a gateway for emerging pathogens and global threats. In 2013, faculty from Montefiore Medical Center and Memorial Sloan Kettering developed a free half-day workshop for postgraduate trainees in antimicrobial stewardship (AS), infection prevention (IP), hospital epidemiology, and public health. This annual workshop, sponsored by the Infectious Diseases Society of New York (IDSNY), incorporates case studies and expert panel discussions on timely topics such as Ebola, Candida auris, Clostridiodes difficile, measles, nosocomial influenza, drug shortages, and AS/IP “big data.” Methods: From 2013 through 2017, the workshop involved 10–15 interactive AS/IP cases with audience response questions and panel discussions. In 2018–2019, based on feedback, the format was revised to emphasize breakout sessions in which participants actively practiced AS/IP tools, (eg, medication utilization evaluations, epidemiologic curves, and performance improvement devices). Examples of 2018–2019 cases are shown in Figure 1. A pre- and postseminar paper survey was conducted yearly to understand baseline training in AS/IP, desire for future AS/IP careers, and self-reported effectiveness of the workshop. Results: Initially, the primary audience was NYC ID fellows. From 2018 onward, we opened enrollment to pharmacy residents. Approximately 45 NYC ID fellows were eligible for the course each year. Results from 2013 to 2016 surveys were reported previously (Fig. 2). There were 32 attendees in 2018, 42 in 2019. The survey response rate was 88% in 2018 and 95% in 2019, with 68 (92%) total participants. Most participants had received previous training in IP (82%) and AS (94%) (Fig. 3). Most participants reported that the program was a good supplement to their ID training (98%) and that case studies were an effective means of learning IP (100%) and AS (98%). Furthermore, 92% stated they would like additional AS/IP training, and many since 2013 have requested a full-day course. Self-reported interest in future involvement in AS/IP increased after the workshop: IP, 68%–83% (P =.04) and AS, 88%–91% (P = .61). Conclusions: Most trainees reported satisfaction with the workshop and case-study learning method; interest in future AS/IP careers increased after the seminar. We intend to explore Funding: to expand to a full-day program for all NYC postgraduate trainees and AS/IP junior faculty. As such, we hope to obtain the endorsement of professional societies such as SHEA. This workshop could address a crucial educational gap in AS/IP postgraduate training and help sustain our future workforce.Funding: NoneDisclosures: None

scholarly journals Engaging and Educating Older Adults and Caregivers in Age-Friendly Healthcare

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 686-686
Author(s):  
Erin Emery-Tiburcio ◽  
Rani Snyder
Keyword(s):  
Older Adults ◽  
New York ◽  
Health System ◽  
Medical Center ◽  
Health Resources ◽  
Primary Care Providers ◽  
Care Providers ◽  
New York University ◽  
The Us ◽  
Treatment Plans

Abstract As the Age-Friendly Health System initiative moves across the US and around the world, not only do health system staff require education about the 4Ms, but older adults, caregivers, and families need education. Engaging and empowering the community about the 4Ms can improve communication, clarify and improve adherence to treatment plans, and improve patient satisfaction. Many methods for engaging the community in age-friendly care are currently in development. Initiated by Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Programs (GWEPs), Community Catalyst is leading the co-design of Age-Friendly Health System materials with older adults and caregivers. Testing these materials across the country in diverse populations of older adults and caregivers will yield open-source documents for local adaptation. Rush University Medical Center is testing a method for identifying, engaging, educating, and providing health services for family caregivers of older adults. This unique program integrates with the Age-Friendly Health System efforts in addressing all 4Ms for caregivers. The Bronx Health Corps (BHC) was created by the New York University Hartford Institute of Geriatric Nursing to educate older adults in the community about health and health behaviors. BHC developed a method for engaging and educating older adults that is replicable in other communities. Baylor College of Medicine adapted and tested the Patient Priorities Care model to educate primary care providers about how to engage older adults in conversations about What Matters to them. Central to the Age-Friendly movement, John A. Hartford Foundation leadership will discuss the implications of this important work.

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