Try a new search

Format these results:

Searched for:

person:lip08

in-biosketch:true

Total Results:

13


Bridging the gap: a resident-led transitional care clinic to improve post hospital care in a safety-net academic community hospital

Li, Patrick; Kang, Tiffany; Carrillo-Argueta, Sandy; Kassapidis, Vickie; Grohman, Rebecca; Martinez, Michael J; Sartori, Daniel J; Hayes, Rachael; Jervis, Ramiro; Moussa, Marwa
The transitional period between hospital discharge and primary care follow-up is a vulnerable time for patients that can result in adverse health outcomes and preventable hospital readmissions. This is especially true for patients of safety-net hospitals (SNHs) who often struggle to secure primary care access when leaving the hospital due to social, economic and cultural barriers. In this study, we describe a resident-led postdischarge clinic that serves patients discharged from NYU Langone Hospital-Brooklyn, an urban safety-net academic hospital. In our multivariable analysis, there was no statistical difference in the readmission rate between those who completed the transitional care management and those who did not (OR 1.32 (0.75-2.36), p=0.336), but there was a statistically significant increase in primary care provider (PCP) engagement (OR 0.53 (0.45-0.62), p<0.001). Overall, this study describes a postdischarge clinic model embedded in a resident clinic in an urban SNH that is associated with increased PCP engagement, but no reduction in 30-day hospital readmissions.
PMCID:10953301
PMID: 38508663
ISSN: 2399-6641
CID: 5640602

Longitudinal Use of Telehealth During the COVID-19 Pandemic and Utility of Asynchronous Testing for Subspecialty-Level Ophthalmic Care

Mosenia, Arman; Li, Patrick; Seefeldt, Rick; Seitzman, Gerami D; Sun, Catherine Q; Kim, Tyson N
IMPORTANCE/UNASSIGNED:Telehealth in ophthalmology has traditionally focused on preventive disease screening with limited use in outpatient evaluation. The unique conditions of the COVID-19 pandemic afforded the opportunity to evaluate different implementations of teleophthalmology at scale, providing insight into expanding teleophthalmology care. OBJECTIVE/UNASSIGNED:To compare telehealth use in ophthalmology with other specialties and assess the feasibility of augmenting ophthalmic telehealth encounters with asynchronous testing during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This quality improvement study evaluated retrospective, longitudinal, observational data from the first 18 months of the COVID-19 pandemic (January 1, 2020, through July 31, 2021) for 881 080 patients receiving care from outpatient primary care, cardiology, neurology, gastroenterology, surgery, neurosurgery, urology, orthopedic surgery, otolaryngology, obstetrics/gynecology, and ophthalmology clinics of the University of California, San Francisco. Asynchronous testing was evaluated for teleophthalmology encounters. INTERVENTIONS/UNASSIGNED:A hybrid care model wherein ophthalmic testing data were acquired asynchronously and used to augment telehealth encounters. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Telehealth as a percentage of total volume of ambulatory care and use of asynchronous testing for ophthalmic conditions. RESULTS/UNASSIGNED:The volume of in-person outpatient visits dropped by 83.3% (39 488 of 47 390) across the evaluated specialties at the onset of shelter-in-place orders for the COVID-19 pandemic, and the initial use of telehealth increased for these specialties before stabilizing over the 18-month study period. In ophthalmology, telehealth use peaked at 488 of 1575 encounters (31.0%) early in the pandemic and returned to mostly in-person visits as COVID-19 restrictions lifted. Elective use of telehealth was highest in gastroenterology, urology, neurology, and neurosurgery and lowest in ophthalmology. Asynchronous testing was combined with 126 teleophthalmology encounters, resulting in change of clinical management for 32 patients (25.4%) and no change for 91 (72.2%). CONCLUSIONS AND RELEVANCE/UNASSIGNED:Telehealth increased across various specialties during the COVID-19 pandemic. Combining teleophthalmic visits with asynchronous testing suggested that this approach is feasible for subspecialty-level evaluation. Additional study is needed to evaluate whether asynchronous testing outside the same institution could provide an effective and lasting approach for expanding the reach of ophthalmic telehealth.
PMID: 36454548
ISSN: 2168-6173
CID: 5374092

Peptidylarginine Deiminases 2 Mediates Caspase-1-Associated Lethality in Pseudomonas aeruginosa Pneumonia-Induced Sepsis

Wu, Zhenyu; Tian, Yuzi; Alam, Hasan B; Li, Patrick; Duan, Xiuzhen; Williams, Aaron M; Liu, Baoling; Ma, Jianjie; Li, Yongqing
BACKGROUND:Pseudomonas aeruginosa (PA) is a pathogenic bacterium that causes severe pneumonia in critically ill and immunocompromised patients. Peptidylarginine deiminase (PAD) 2, PAD4, and caspase-1 are important enzymes in mediating host response to infection. The goal of this study was to determine the interplay between PAD2, PAD4, and caspase-1 in PA pneumonia-induced sepsis. METHODS:Pneumonia was produced in wild-type, Pad2-/-, and Pad4-/- mice by intranasal inoculation of PA (2.5 × 106 colony-forming units per mouse), and survival (n = 15/group) was monitored for 10 days. Bone marrow-derived macrophages (BMDMs) were isolated for in vitro studies. Samples were collected at specific timepoints for Western blot, bacterial load determination, and flow cytometry analysis. RESULTS:Caspase-1-dependent inflammation was diminished in PA-inoculated Pad2-/- mice, contributing to reduced macrophage death and enhanced bacterial clearance. In addition, Pad2-/- mice exhibited improved survival and attenuated acute lung injury after PA infection. In contrast, Pad4-/- mice did not display diminished caspase-1 activation, altered bacterial loads, or improved survival. CONCLUSIONS:Peptidylarginine deiminase 2 plays an essential role in the pathogenesis of pulmonary sepsis by mediating caspase-1 activation. This goes against previous findings of PAD4 in sepsis. Our study suggests that PAD2 is a potential therapeutic target of PA pneumonia-induced sepsis.
PMID: 32729925
ISSN: 1537-6613
CID: 5326762

Comparison of automated and expert human grading of diabetic retinopathy using smartphone-based retinal photography

Kim, Tyson N; Aaberg, Michael T; Li, Patrick; Davila, Jose R; Bhaskaranand, Malavika; Bhat, Sandeep; Ramachandra, Chaithanya; Solanki, Kaushal; Myers, Frankie; Reber, Clay; Jalalizadeh, Rohan; Margolis, Todd P; Fletcher, Daniel; Paulus, Yannis M
PURPOSE:The aim of this study is to investigate the efficacy of a mobile platform that combines smartphone-based retinal imaging with automated grading for determining the presence of referral-warranted diabetic retinopathy (RWDR). METHODS:A smartphone-based camera (RetinaScope) was used by non-ophthalmic personnel to image the retina of patients with diabetes. Images were analyzed with the Eyenuk EyeArt® system, which generated referral recommendations based on presence of diabetic retinopathy (DR) and/or markers for clinically significant macular oedema. Images were independently evaluated by two masked readers and categorized as refer/no refer. The accuracies of the graders and automated interpretation were determined by comparing results to gold standard clinical diagnoses. RESULTS:A total of 119 eyes from 69 patients were included. RWDR was present in 88 eyes (73.9%) and in 54 patients (78.3%). At the patient-level, automated interpretation had a sensitivity of 87.0% and specificity of 78.6%; grader 1 had a sensitivity of 96.3% and specificity of 42.9%; grader 2 had a sensitivity of 92.5% and specificity of 50.0%. At the eye-level, automated interpretation had a sensitivity of 77.8% and specificity of 71.5%; grader 1 had a sensitivity of 94.0% and specificity of 52.2%; grader 2 had a sensitivity of 89.5% and specificity of 66.9%. DISCUSSION:Retinal photography with RetinaScope combined with automated interpretation by EyeArt achieved a lower sensitivity but higher specificity than trained expert graders. Feasibility testing was performed using non-ophthalmic personnel in a retina clinic with high disease burden. Additional studies are needed to assess efficacy of screening diabetic patients from general population.
PMCID:7852658
PMID: 32341536
ISSN: 1476-5454
CID: 5326792

Peptidylarginine Deiminase 2 in Host Immunity: Current Insights and Perspectives

Wu, Zhenyu; Li, Patrick; Tian, Yuzi; Ouyang, Wenlu; Ho, Jessie Wai-Yan; Alam, Hasan B; Li, Yongqing
Peptidylarginine deiminases (PADs) are a group of enzymes that catalyze post-translational modifications of proteins by converting arginine residues into citrullines. Among the five members of the PAD family, PAD2 and PAD4 are the most frequently studied because of their abundant expression in immune cells. An increasing number of studies have identified PAD2 as an essential factor in the pathogenesis of many diseases. The successes of preclinical research targeting PAD2 highlights the therapeutic potential of PAD2 inhibition, particularly in sepsis and autoimmune diseases. However, the underlying mechanisms by which PAD2 mediates host immunity remain largely unknown. In this review, we will discuss the role of PAD2 in different types of cell death signaling pathways and the related immune disorders contrasted with functions of PAD4, providing novel therapeutic strategies for PAD2-associated pathology.
PMCID:8599989
PMID: 34804050
ISSN: 1664-3224
CID: 5326772

Citrullinated Histone H3 Mediates Sepsis-Induced Lung Injury Through Activating Caspase-1 Dependent Inflammasome Pathway

Tian, Yuzi; Li, Patrick; Wu, Zhenyu; Deng, Qiufang; Pan, Baihong; Stringer, Kathleen A; Alam, Hasan B; Standiford, Theodore J; Li, Yongqing
Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection that often results in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). An emerging mechanism of sepsis-induced ARDS involves neutrophils/macrophages undergoing cell death, releasing nuclear histones to cause tissue damage that exacerbates pulmonary injury. While published studies focus on unmodified histones, little is known about the role of citrullinated histone H3 (CitH3) in the pathogenesis of sepsis and ALI. In this study, we found that levels of CitH3 were elevated in the patients with sepsis-induced ARDS and correlated to PaO2/FiO2 in septic patients. Systematic administration of CitH3 peptide in mice provoked Caspase-1 activation in the lung tissue and caused ALI. Neutralization of CitH3 with monoclonal antibody improved survival and attenuated ALI in a mouse sepsis model. Furthermore, we demonstrated that CitH3 induces ALI through activating Caspase-1 dependent inflammasome in bone marrow derived macrophages and bone marrow derived dendritic cells. Our study suggests that CitH3 is an important mediator of inflammation and mortality during sepsis-induced ALI.
PMCID:8688857
PMID: 34950139
ISSN: 1664-3224
CID: 5326782

ACUTE MANIA: AN UNUSUAL PRESENTATION OF SMALL CELL LUNG CANCER [Meeting Abstract]

Li, P.; Hayon, J.; Mahowald, C.
ISI:000546434900262
ISSN: 0012-3692
CID: 4573302

Usability testing of a smartphone-based retinal camera among first-time users in the primary care setting

Li, Patrick; Paulus, Yannis M; Davila, Jose R; Gosbee, John; Margolis, Todd; Fletcher, Daniel A; Kim, Tyson N
Smartphone-based retinal photography is a promising method for increasing accessibility of retinal screening in the primary care and community settings. Recent work has focused on validating its use in detection of diabetic retinopathy. However, retinal imaging can be technically challenging and additional work is needed to improve ease of retinal imaging in the primary care setting. We therefore performed usability testing of a smartphone-based retinal camera, RetinaScope, among medical assistants in primary care who had never performed retinal imaging. A total of 24 medical assistants performed first-time imaging in a total of five rounds of testing, and iterative improvements to the device were made between test rounds based on the results. The time to acquire a single ~50 degree image of the posterior pole of a model eye decreased from 283 ± 60 seconds to 34 ± 17 seconds (p < 0.01) for first-time users. The time to acquire 5 overlapping images of the retina decreased from 325 ± 60 seconds to 118 ± 26 seconds (p = 0.02) for first-time users. Testing in the human eye demonstrated that a single wide-view retinal image could be captured in 65 ± 7 seconds and 5 overlapping images in 229 ± 114 seconds. Users reported high Systems Usability Scores of 86 ± 13 throughout the rounds, reflecting a high level of comfort in first-time operation of the device. Our study demonstrates that smartphone-based retinal photography has the potential to be quickly adopted among medical assistants in the primary care setting.
PMCID:7455018
PMID: 32864157
ISSN: 2055-642x
CID: 5326812

Deep neural network and human evaluation of referral-warranted diabetic retinopathy using smartphone-based retinal photographs [Meeting Abstract]

Aaberg, Michael; Kim, Tyson; Li, Patrick; Niziol, Leslie; Bhaskaranand, Malavika; Bhat, Sandeep; Ramachandra, Chaithanya; Solanki, Kaushal; Davila, Jose; Myers, Frankie; Reber, Clay; Musch, David C.; Margolis, Todd; Fletcher, Daniel; Paulus, Yannis Mantas
ISI:000488628103218
ISSN: 0146-0404
CID: 5326842

A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging

Kim, Tyson N; Myers, Frank; Reber, Clay; Loury, P J; Loumou, Panagiota; Webster, Doug; Echanique, Chris; Li, Patrick; Davila, Jose R; Maamari, Robi N; Switz, Neil A; Keenan, Jeremy; Woodward, Maria A; Paulus, Yannis M; Margolis, Todd; Fletcher, Daniel A
PURPOSE/OBJECTIVE:High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. METHODS:The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. RESULTS:The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. CONCLUSIONS:Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. TRANSLATIONAL RELEVANCE/CONCLUSIONS:Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening.
PMCID:6166894
PMID: 30280006
ISSN: 2164-2591
CID: 5326802