Faculty Bibliography

Background Emergency Department (ED) handoff to inpatient teams is a potential source of error. Generative Artificial Intelligence (AI) has shown promise in succinctly summarizing large quantities of clinical data and may help improve Emergency Department (ED) handoff. Objectives Our objectives were to: 1) evaluate the accuracy, clinical utility, and safety of AI-generated ED-to-inpatient handoff summaries; 2) identify patient and visit characteristics influencing summary effectiveness; and 3) characterize potential error patterns to inform implementation strategies. Methods This exploratory study evaluated AI-generated handoff summaries at an urban academic ED (February-April 2024). A HIPAA-compliant GPT-4 model generated summaries aligned with the IPASS framework; ED providers assessed summary accuracy, usefulness, and safety through on-shift surveys. Results Among 50 cases, median quality and usefulness scores were 4/5 (SE = 0.13). Safety concerns arose in 6% of cases, with issues including data omissions and mischaracterizations. Consultation status significantly affected usefulness scores (p < 0.05). Omissions of relevant medications, laboratory results, and other essential detailss were noted (n=6), and EM clinicians disagreed with some AI characterizations of patient stability, vitals and workup (n=8). The most common response was positive impressions of the technology incorporated into the handoff process (n=11). Conclusions This exploratory provider-in-the-loop model demonstrated clinical acceptability and highlighted areas for refinement. Future studies should incorporate recipient perspectives and examine clinical outcomes to scale and optimize AI implementation.

OBJECTIVES/OBJECTIVE:Rural residents face unique challenges that contribute to poor diet quality and health. The objective of this study was to assess diet quality using the Alternative Healthy Eating Index (aHEI) among residents of a rural New York county with poor health outcomes, and identify geographic and individual-level factors associated with lower diet quality. DESIGN/METHODS:We performed a cross-sectional study using survey data and multivariable linear regression analyses, supplemented by geographic distribution assessment of aHEI scores. SETTING/METHODS:Sullivan County, New York, a rural county with poor health outcomes. PARTICIPANTS/METHODS:Households in Sullivan County who responded to a dietary and sociodemographic health survey in 2021-2022. OUTCOME MEASURES/METHODS:The primary outcome was the aHEI score and its dietary subscores. Secondary measures included sociodemographic characteristics, receipt of income assistance, financial hardship, food and housing insecurity, primary food store type, distance to food store and frequency of canned or plastic-wrapped food consumption. RESULTS:The overall survey response rate was 42.5%. The mean aHEI score was 56.5 (SD: 11.9), normally distributed across respondents. Lower aHEI scores were associated with not completing high school (10.0 points lower vs college graduates, p<0.01), reporting a disability (3.5 points lower, p<0.01), experiencing food insecurity (3.0 points lower, p<0.01) and frequent consumption of canned foods (6.2 points lower compared with those who never consumed canned foods, p<0.01). Geographic analysis revealed clustering of predictors but no substantial geographic clustering of aHEI scores. CONCLUSIONS:Poor diet quality in rural areas is associated with education level, disability, food insecurity and canned food consumption. These findings highlight potentially modifiable risk factors and support the need for targeted interventions to improve diet quality and reduce health disparities in rural populations.

OBJECTIVE:To compare alternative Healthy Eating Index (aHEI) scores among residents with or without diabetes in a rural county and analyze food/drink subgroups for notable differences between the 2 groups. METHODS:We performed cross-sectional surveys and validated food frequency questionnaires among rural residents in Sullivan County, New York. We compared total aHEI and component scores between participants with and without diabetes. RESULTS:The 155 respondents with diabetes were older, less frequently non-Hispanic White, and had higher mean body mass index than the 961 respondents without diabetes. We found lower aHEI scores among participants with diabetes (54.1) than those without (56.7) (P = 0.001). Respondents with diabetes had significantly lower component scores for alcoholic beverages, red meat, nuts/legumes, and trans-fats than those without diabetes. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Our findings highlight the need for nutrition education in high-risk rural communities. We also identified specific food/drink categories among rural residents with diabetes that should be targeted to improve glycemic control.

Acute rheumatic fever (ARF) is an immune-mediated nonsuppurative complication of group A streptococcal (GAS) pharyngitis. Approximately 470,000 new cases of ARF occur annually, with a more significant disease burden in developing countries with higher rates of untreated or inadequately treated GAS infections. Globally, over 275,000 deaths yearly are attributed to rheumatic heart disease (RHD). The most significant contributors to the spread of GAS pharyngitis are household overcrowding, poor sanitation, and inadequate access to healthcare. The pathophysiology of ARF is characterized by an aberrant immune response to GAS infection triggered by molecular mimicry between GAS antigens and self-antigens. This immune response typically manifests 2 to 4 weeks after the initial GAS infection and may lead to the development of carditis, valvulitis, Sydenham chorea, subcutaneous nodules, erythema marginatum, and polyarthritis that is usually migratory. The severity and distribution of these manifestations vary significantly between individuals making the diagnosis of ARF challenging. Early recognition of ARF using the modified Jones criteria is essential in treating acute infection and preventing complications. A major long-term consequence is RHD, which carries significant morbidity and mortality.

CASE PRESENTATION/METHODS:We describe a case of persistent odynophagia due to a retained foreign body 27 days after emergent intubation. DISCUSSION/CONCLUSIONS:Dentures constitute a potential esophageal foreign body and warrant special consideration during airway management. Odynophagia, dysphagia, and changes in phonation should prompt consideration of retained esophageal foreign bodies, especially in the post-intubation setting.

OBJECTIVE/UNASSIGNED:To perform a geospatial analysis of food insecurity in a rural county known to have poor health outcomes and assess the effect of the COVID-19 pandemic. METHODS/UNASSIGNED:In 2020, we mailed a comprehensive cross-sectional survey to all households in Sullivan County, a rural county with the second-worst health outcomes among all counties in New York State. Surveys of households included validated food insecurity screening questions. Questions were asked in reference to 2019, prior to the pandemic, and for 2020, in the first year of the pandemic. Respondents also responded to demographic questions. Raking adjustments were performed using age, sex, race/ethnicity, and health insurance strata to mitigate non-response bias. To identify significant hotspots of food insecurity within the county, we also performed geospatial analysis. FINDINGS/UNASSIGNED:From the 28,284 households surveyed, 20% of households responded. Of 4725 survey respondents, 26% of households reported experiencing food insecurity in 2019, and in 2020, this proportion increased to 35%. In 2020, 58% of Black and Hispanic households reported experiencing food insecurity. Food insecurity in 2020 was also present in 58% of unmarried households with children and in 64% of households insured by Medicaid. The geospatial analyses revealed that hotspots of food insecurity were primarily located in or near more urban areas of the rural county. CONCLUSIONS/UNASSIGNED:Our countywide health survey in a high-risk rural county identified significant increases of food insecurity in the first year of the COVID-19 pandemic, despite national statistics reporting a stable rate. Responses to future crises should include targeted interventions to bolster food security among vulnerable rural populations.

INTRODUCTION/BACKGROUND:Antenatal lead exposure is associated with multiple adverse maternal and fetal consequences. Maternal blood lead concentrations as low as 10 µg/dL have been associated with gestational hypertension, spontaneous abortion, growth retardation, and impaired neurobehavioral development. Current treatment recommendations for pregnant women with a blood lead level (BLL) ≥ 45 µg/dL include chelation. We report a successful case of a mother with severe gestational lead poisoning treated with induction of labor in a term infant. CASE REPORT/METHODS:A 22-year-old G2P1001 female, at 38 weeks and 5 days gestation, was referred to the emergency department for an outpatient venous BLL of 53 µg/dL. The decision was made to limit ongoing prenatal lead exposure by emergent induction as opposed to chelation. Maternal BLL just prior to induction increased to 70 µg/dL. A 3510 g infant was delivered with APGAR scores of 9 and 9 at 1 and 5 min. Cord BLL at delivery returned at 41 µg/dL. The mother was instructed to avoid breastfeeding until her BLLs decreased to below 40 µg/dL, consistent with federal and local guidelines. The neonate was empirically chelated with dimercaptosuccinic acid. On postpartum day 2, maternal BLL decreased to 36 µg/dL, and the neonatal BLL was found to be 33 µg/mL. Both the mother and neonate were discharged to an alternative lead-free household on postpartum day 4.