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75


Feasibility and impact of implementing buprenorphine initiation programs in three heterogenous rural and urban emergency departments [Meeting Abstract]

McCormack, R P; Rotrosen, J; D'Onofrio, G; Gauthier, P; Marsch, L A; Matthews, A; Mulatya, C; Edelman, E J; Farkas, S; Fiellin, D A; Goodman, W; Huntley, K; Knight, R; Liu, D; Meyers-Ohki, S; Novo, P; Shin, S -M; Wall, S P; Hawk, K
Background and Objectives: To rapidly develop, implement, and evaluate emergency department (ED) clinical protocols for initiation of buprenorphine (E
EMBASE:632418168
ISSN: 1553-2712
CID: 4547932

Community-Based Hemoglobin A1C Testing in Barbershops to Identify Black Men With Undiagnosed Diabetes

Osorio, Marcela; Ravenell, Joseph E; Sevick, Mary A; Ararso, Yonathan; Young, Ta'Loria; Wall, Stephen P; Lee, David C
PMID: 31985740
ISSN: 2168-6114
CID: 4293912

The unique moral permissibility of uncontrolled lung donation after circulatory death

Parent, Brendan; Caplan, Arthur; Angel, Luis; Kon, Zachary; Dubler, Nancy; Goldfrank, Lewis; Lindner, Jacob; Wall, Stephen P
Implementing uncontrolled donation after circulatory determination of death (uDCDD) in the United States could markedly improve supply of donor lungs for patients in need of transplants. Evidence from U.S. pilot programs suggests families support uDCDD, but only if they are asked permission for using invasive organ preservation procedures prior to initiation. However, non-invasive strategies that confine oxygenation to lungs may be applicable to the overwhelming majority of potential uDCDD donors that have airway devices in place as part of standard resuscitation. We propose an ethical framework for lung uDCDD by: (1) initiating post mortem preservation without requiring prior permission to protect the opportunity for donation until an authorized party can be found; (2) using non-invasive strategies that confine oxygenation to lungs; and (3) maintaining strict separation between the healthcare team and the organ preservation team. Attempting uDCDD in this way has great potential to obtain more transplantable lungs while respecting donor autonomy and family wishes, securing public support, and enabling authorized persons to affirm or cease preservation decisions without requiring evidence of prior organ donation intent. It ensures prioritization of life-saving, the opportunity to allow willing donors to donate, and respect for bodily integrity while adhering to current ethical norms.
PMID: 31550420
ISSN: 1600-6143
CID: 4105452

US Organ Donation Policy [Comment]

Wall, Stephen P; Parent, Brendan; Caplan, Arthur
PMID: 31961413
ISSN: 1538-3598
CID: 4273852

Community-Based Hemoglobin A1C Testing in Barbershops to Identify Black Men with Undiagnosed Diabetes [Letter]

Osorio, M; Ravenell, J E; Sevick, M A; Ararso, Y; Young, T; Wall, S P; Lee, D C
EMBASE:630713293
ISSN: 2168-6106
CID: 4296472

EXTENDED-RELEASE NALTREXONE WAS FEASIBLE, ACCEPTABLE, AND REDUCED DRINKING IN PATIENTS WITH ALCOHOL USE DISORDERS WHO FREQUENT THE EMERGENCY DEPARTMENT [Meeting Abstract]

McCormack, R. P.; Rotrosen, J.; Wall, S. P.; Moran, Z.; Goldfrank, L.; Lee, J.; Doran, K. M.; Shin, S.; D\Onofrio, G.
ISI:000540372300600
ISSN: 0145-6008
CID: 4573282

Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls

Gorenstein, Scott A; Castellano, Michael L; Slone, Eric S; Gillette, Brian; Liu, Helen; Alsamarraie, Cindy; Jacobson, Alan M; Wall, Stephen P; Adhikari, Samrachana; Swartz, Jordan L; McMullen, Jenica J S; Osorio, Marcela; Koziatek, Christian A; Lee, David C
Objective/UNASSIGNED:Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress. Methods/UNASSIGNED:This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation. Results/UNASSIGNED:We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046). Conclusion/UNASSIGNED:Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.
PMID: 32931666
ISSN: 1066-2936
CID: 4591182

Age Disparities Among Patients With Type 2 Diabetes and Associated Rates of Hospital Use and Diabetic Complications

Lee, David C; Young, Ta'Loria; Koziatek, Christian A; Shim, Christopher J; Osorio, Marcela; Vinson, Andrew J; Ravenell, Joseph E; Wall, Stephen P
INTRODUCTION/BACKGROUND:Although screening for diabetes is recommended at age 45, some populations may be at greater risk at earlier ages. Our objective was to quantify age disparities among patients with type 2 diabetes in New York City. METHODS:Using all-payer hospital claims data for New York City, we performed a cross-sectional analysis of patients with type 2 diabetes identified from emergency department visits during the 5-year period 2011-2015. We estimated type 2 diabetes prevalence at each year of life, the age distribution of patients stratified by decade, and the average age of patients by sex, race/ethnicity, and geographic location. RESULTS:We identified 576,306 unique patients with type 2 diabetes. These patients represented more than half of all people with type 2 diabetes in New York City. Patients in racial/ethnic minority groups were on average 5.5 to 8.4 years younger than non-Hispanic white patients. At age 45, type 2 diabetes prevalence was 10.9% among non-Hispanic black patients and 5.2% among non-Hispanic white patients. In our geospatial analyses, patients with type 2 diabetes were on average 6 years younger in hotspots of diabetes-related emergency department use and inpatient hospitalizations. The average age of patients with type 2 diabetes was also 1 to 2 years younger in hotspots of microvascular diabetic complications. CONCLUSION/CONCLUSIONS:We identified profound age disparities among patients with type 2 diabetes in racial/ethnic minority groups and in neighborhoods with poor health outcomes. The younger age of these patients may be due to earlier onset of diabetes and/or earlier death from diabetic complications. Our findings demonstrate the need for geographically targeted interventions that promote earlier diagnosis and better glycemic control.
PMID: 31370917
ISSN: 1545-1151
CID: 4011382

Associations between age disparities in type 2 diabetes and rates of diabetes-related hospital use and diabetic complications [Meeting Abstract]

Lee, D C; Young, T; Koziatek, C A; Shim, C J; Osorio, M; Vinson, A J; Ravenell, J; Wall, S P
Background: Current guidelines for diabetes screening start at age 45, but disparities in certain subgroups exist and poor diabetic outcomes are known to cluster in specific neighborhoods. The objective of this study was to quantify disparities in the age distribution of patients with type 2 diabetes by sex, race/ethnicity, and geographic location. We also studied how patient age relates to diabetes-related hospital use and development of diabetic complications.
Method(s): Using all-payer hospital claims data, we performed a cross-sectional analysis of patients with type 2 diabetes. Our study included patients in New York City as identified by geocoded home address. Patients aged 10 to 100 years old were identified as having type 2 diabetes based on diagnosis codes from emergency claims data from 2011-2015. Our main measures included the estimated prevalence of type 2 diabetes at each year of life, the age distribution of patients as stratified by decade, and the comparison of patient age in geographic hotspots of frequent diabetes-related hospital use and diabetic complications.
Result(s): We identified 576,306 unique patients diagnosed with type 2 diabetes, which represented over half of all cases in New York City. Minority subgroups were on average 5.5 to 8.4 years younger than non-Hispanic White patients. Males with type 2 diabetes were 2.6 years younger than females. At 45 years of age, the estimated prevalence of type 2 diabetes was 10.9% among Black patients compared to 5.2% among White patients. In our geospatial analyses, patients with type 2 diabetes were on average 5.9 years younger in hotspots of diabetes-related emergency department use and inpatient hospitalizations. The average age of patients with type 2 diabetes was 1.5 to 2.2 years younger in hotspots of microvascular diabetic complications.
Conclusion(s): We identified profound disparities in the age of patients with type 2 diabetes among minorities and in neighborhoods with poor health outcomes. The younger age of these patients may be due to earlier onset of diabetes and/or earlier death from diabetes-related complications. Our findings demonstrate the need for geographically targeted interventions that promote earlier diagnosis and better glycemic control to reduce disparities in diabetes burden. [Figure Presented] Age Distribution of Patients with Type 2 Diabetes by Race and Ethnicity
EMBASE:629001355
ISSN: 1525-1497
CID: 4053252

Using Geospatial Analysis and Emergency Claims Data to Improve Minority Health Surveillance

Lee, David C; Yi, Stella S; Athens, Jessica K; Vinson, Andrew J; Wall, Stephen P; Ravenell, Joseph E
Traditional methods of health surveillance often under-represent racial and ethnic minorities. Our objective was to use geospatial analysis and emergency claims data to estimate local chronic disease prevalence separately for specific racial and ethnic groups. We also performed a regression analysis to identify associations between median household income and local disease prevalence among Black, Hispanic, Asian, and White adults in New York City. The study population included individuals who visited an emergency department at least once from 2009 to 2013. Our main outcomes were geospatial estimates of diabetes, hypertension, and asthma prevalence by Census tract as stratified by race and ethnicity. Using emergency claims data, we identified 4.9 million unique New York City adults with 28.5% of identifying as Black, 25.2% Hispanic, and 6.1% Asian. Age-adjusted disease prevalence was highest among Black and Hispanic adults for diabetes (13.4 and 13.1%), hypertension (28.7 and 24.1%), and asthma (9.9 and 10.1%). Correlation between disease prevalence maps demonstrated moderate overlap between Black and Hispanic adults for diabetes (0.49), hypertension (0.57), and asthma (0.58). In our regression analysis, we found that the association between low income and high disease prevalence was strongest for Hispanic adults, whereas increases in income had more modest reductions in disease prevalence for Black adults, especially for diabetes. Our geographically detailed maps of disease prevalence generate actionable evidence that can help direct health interventions to those communities with the highest health disparities. Using these novel geographic approaches, we reveal the underlying epidemiology of chronic disease for a racially and culturally diverse population.
PMCID:5803484
PMID: 28791583
ISSN: 2196-8837
CID: 2664112