Faculty Bibliography
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department:Medicine. General Internal Medicine
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Joint Commission journal on quality & patient safety. 2021:47(6):343-346.DOI: 10.1016/j.jcjq.2021.02.003
A Sleep Hygiene Intervention to Improve Sleep Quality for Hospitalized Patients
INTRODUCTION/BACKGROUND:Poor sleep is a pervasive problem for hospitalized patients and can contribute to adverse health outcomes. METHODS:We aimed to improve self-reported sleep for patients on a general medicine ward as measured by the Richards-Campbell Sleep Questionnaire (RCSQ) as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question addressing quietness at night. We utilized a non-pharmacologic sleep hygiene bundle composed of a short script with sleep hygiene prompts, such as whether patients would like the shades closed or the lights turned off, as well as a sleep package including an eye mask, earplugs, lavender scent pad, and non-caffeinated tea. Relaxing music was played at bedtime and signs promoting the importance of quietness at night were placed around the unit. Front-line champions were identified to aid with implementation. RESULTS:A total of 931 patients received the intervention. In a sample of surveyed patients, we observed an increase in the RCSQ global score from 6.0 (IQR 3.0-7.0) to 6.2 (IQR 4.0-7.8) from the pre- to post- intervention periods (p = 0.041), as well as increases in three of the five individual survey components. Additionally, HCAHPS "quietness at night" score increased on the unit from 34.1% pre-intervention to 42.5% post-intervention. CONCLUSION/CONCLUSIONS:A nonpharmacologic sleep hygiene protocol paired with provider education and use of champions was associated with modest improvements in patients' perceived sleep and unit HCAHPS scores.
PMID: 33744173
ISSN: 1938-131x
CID: 4871662
An Exploratory Study of Goals of Care Conversations Initiated with Seriously Ill Veterans in the Emergency Room
PMID: 33170071
ISSN: 1557-7740
CID: 4675912
Assessment of quantitative [18F]Sodium fluoride PET measures of knee subchondral bone perfusion and mineralization in osteoarthritic and healthy subjects
OBJECTIVE:F]NaF uptake in subchondral bone of individuals with and without knee osteoarthritis (OA). METHODS:) were evaluated using the Hawkins 3-compartment model. Measures were compared between structurally normal-appearing bone regions and those with structural findings. RESULTS:, and extraction fraction were significantly different between Healthy subjects and subjects with OA. Between-group differences in metabolic parameters were observed both in regions where the OA group had degenerative changes as well as in regions that appeared structurally normal. CONCLUSIONS:F]NaF PET imaging can complement assessments of structural abnormalities observed on MRI.
PMCID:8159876
PMID: 33639259
ISSN: 1522-9653
CID: 5579182
Increased prevalence of lumbar spine monosodium urate deposition among gout patients on dual-energy CT [Meeting Abstract]
Background: Gout affecting the spine is reported as a rare event presenting with neuropathy, spinal compression and acute back pain (1). Cases are often diagnosed by tissue confirmation of monosodium urate (MSU) deposition. The frequency of gout involving the spine asymptomatically or with milder, non-specific symptoms is likely higher than reported.
Objective(s): Using dual-energy CT (DECT), we are determining prevalence/ extent of MSU deposition in the lumbosacral spines of patients with gout and tophaceous gout, compared to non-gout controls.
Method(s): We are recruiting 25 controls, 25 non-tophaceous and 25 tophaceous gout patients, 45-80 years old. Exclusion criteria include CPPD disease, RA, spondyloarthropathy or spinal malignancy. All gout subjects meet ACR gout classification criteria with entry serum urate (sU) of >6.8 mg/dL, or sU >6.0 mg/dL on ULT for <6 months. Demographics, gout history, Aberdeen back pain scale, sU, ESR, and CRP are collected. DECT of the lumbosacral spine is used to assess MSU deposition and osteoarthritic changes.
Result(s): 63 subjects are enrolled and analyzed to date (25 control, 23 non-tophaceous and 15 tophaceous gout). Control, non-tophaceous gout, and tophaceous gout subjects have similar mean age in years (controls 61.8+/-3.8, non-tophaceous 64.0+/-6.2, tophaceous 63.5+/-9.2, p=0.45), but differ in BMI (controls 28.3+/-6.5 kg/ m2, non-tophaceous 32.1+/-6.7 kg/m2, tophaceous 29.1+/-4.3 kg/m2, p=0.01) and creatinine (controls 1.0+/-0.2 mg/dL, non-tophaceous 1.4+/-0.6 mg/dL, tophaceous 1.7+/-0.9 mg/dL, p=0.048). Mean sU and ESR are higher in gout subjects (sU-controls 5.3+/-1 mg/dL, non-tophaceous 8.3+/-1.4 mg/dL, tophaceous 8.4+/-2.0 mg/ dL, p<0.05; ESR-controls 13.7+/-13.8 mm/h, non-tophaceous 25.2+/-18.7 mm/h, tophaceous 22.5+/-15.1 mm/h, p<0.05). Using default threshold settings for MSU visualization, greater MSU deposition is observed in the spine of gout patients (controls 2.2+/-1.2 cm3, non-tophaceous 4.5+/-4.3 cm3, tophaceous 8.5+/-12.5 cm3, p<0.05; Table 1). Reanalysis of several scans using narrower threshold settings to limit possible artifact confirms increased MSU signal among gout patients. Although many subjects in each group do not have excessive MSU deposition, deposition is more common in both gout groups. No subject demonstrated a frank spinal tophus.
Conclusion(s): Based on preliminary results, gout patients have higher inflammatory markers and greater spinal MSU deposition than controls. Preliminary analyes with more stringent DECT threshold settings suggests these differences are not artifact, but analysis is ongoing. These data suggest that MSU deposition in the spine occurs in a subset of gout patients
Objective(s): Using dual-energy CT (DECT), we are determining prevalence/ extent of MSU deposition in the lumbosacral spines of patients with gout and tophaceous gout, compared to non-gout controls.
Method(s): We are recruiting 25 controls, 25 non-tophaceous and 25 tophaceous gout patients, 45-80 years old. Exclusion criteria include CPPD disease, RA, spondyloarthropathy or spinal malignancy. All gout subjects meet ACR gout classification criteria with entry serum urate (sU) of >6.8 mg/dL, or sU >6.0 mg/dL on ULT for <6 months. Demographics, gout history, Aberdeen back pain scale, sU, ESR, and CRP are collected. DECT of the lumbosacral spine is used to assess MSU deposition and osteoarthritic changes.
Result(s): 63 subjects are enrolled and analyzed to date (25 control, 23 non-tophaceous and 15 tophaceous gout). Control, non-tophaceous gout, and tophaceous gout subjects have similar mean age in years (controls 61.8+/-3.8, non-tophaceous 64.0+/-6.2, tophaceous 63.5+/-9.2, p=0.45), but differ in BMI (controls 28.3+/-6.5 kg/ m2, non-tophaceous 32.1+/-6.7 kg/m2, tophaceous 29.1+/-4.3 kg/m2, p=0.01) and creatinine (controls 1.0+/-0.2 mg/dL, non-tophaceous 1.4+/-0.6 mg/dL, tophaceous 1.7+/-0.9 mg/dL, p=0.048). Mean sU and ESR are higher in gout subjects (sU-controls 5.3+/-1 mg/dL, non-tophaceous 8.3+/-1.4 mg/dL, tophaceous 8.4+/-2.0 mg/ dL, p<0.05; ESR-controls 13.7+/-13.8 mm/h, non-tophaceous 25.2+/-18.7 mm/h, tophaceous 22.5+/-15.1 mm/h, p<0.05). Using default threshold settings for MSU visualization, greater MSU deposition is observed in the spine of gout patients (controls 2.2+/-1.2 cm3, non-tophaceous 4.5+/-4.3 cm3, tophaceous 8.5+/-12.5 cm3, p<0.05; Table 1). Reanalysis of several scans using narrower threshold settings to limit possible artifact confirms increased MSU signal among gout patients. Although many subjects in each group do not have excessive MSU deposition, deposition is more common in both gout groups. No subject demonstrated a frank spinal tophus.
Conclusion(s): Based on preliminary results, gout patients have higher inflammatory markers and greater spinal MSU deposition than controls. Preliminary analyes with more stringent DECT threshold settings suggests these differences are not artifact, but analysis is ongoing. These data suggest that MSU deposition in the spine occurs in a subset of gout patients
EMBASE:635708608
ISSN: 1468-2060
CID: 4971742
Defining Valid Activity Monitor Data: A Multimethod Analysis of Weight-Loss Intervention Participants' Barriers to Wear and First 100 Days of Physical Activity
Despite the popularity of commercially available wearable activity monitors (WAMs), there is a paucity of consistent methodology for analyzing large amounts of accelerometer data from these devices. This multimethod study aimed to inform appropriate Fitbit wear thresholds for physical activity (PA) outcomes assessment in a sample of 616 low-income, majority Latina patients with obesity enrolled in a behavioral weight-loss intervention. Secondly, this study aimed to understand intervention participants' barriers to Fitbit use. We applied a heart rate (HR) criterion (≥10 h/day) and a step count (SC) criterion (≥1000 steps/day) to 100 days of continuous activity monitor data. We examined the prevalence of valid wear and PA outcomes between analytic subgroups of participants who met the HR criterion, SC criterion, or both. We undertook qualitative analysis of research staff notes and participant interviews to explore barriers to valid Fitbit data collection. Overall, one in three participants did not meet the SC criterion for valid wear in Weeks 1 and 13; however, we found the SC criterion to be more inclusive of participants who did not use a smartphone than the HR criterion. Older age, higher body mass index (BMI), barriers to smartphone use, device storage issues, and negative emotional responses to WAM-based self-monitoring may predict higher proportions of invalid WAM data in weight-loss intervention research.
PMCID:9754231
PMID: 36530339
ISSN: 2227-9709
CID: 5387092
An international validation of knowledge-based planning [Meeting Abstract]
Purpose: To carry out a large international validation of how dose prediction quality translates to plan quality in a radiotherapy knowledge-based planning (KBP) process.
Method(s): We collected dose predictions for head-and-neck cancer radiotherapy from 21 different research groups internationally who participated in the OpenKBP Grand Challenge. Each research group used the same training dataset (n=200) and validation dataset (n=40) to develop their methods. These methods predicted dose on a testing dataset (n=100), and those 2100 unique dose predictions were input to a previously published plan optimization method to generate 2100 treatment plans. The predictions and plans were compared to the ground truth dose via: (1)error, the mean absolute voxel-by-voxel difference in dose; and (2) quality, the mean and maximum deviation across 23 dose-volume histogram (DVH) criteria.
Result(s): The range in median prediction error among the top 20 methods was 2.3Gy to 12.0Gy, which was 6.8Gy wider than the range in median plan error of 2.1Gy to 5.0Gy. One method also achieved significantly lower prediction error (P<0.05; one-sided Wilcoxon test) than all the other methods, however, it generated plans with error that was not significantly lower than 28.6% of the other methods. Additionally, predicted dose was consistently lower quality than plan dose. Half (n=1050) of all predictions and plans had an average deviation that was 0.1Gy worse and 0.8Gy better than the ground truth dose, respectively. Similarly, half of all predictions had a maximum deviation that was 3.7Gy worse than the ground truth dose, which was 1.0Gy worse than half of all plans.
Conclusion(s): Many dose prediction methods can achieve low error, however, optimization often improves upon the predictions and eliminates significant differences between prediction methods. Thus, it is critical that we improve the optimization stage in KBP to get better utility out of the existing high-quality dose prediction methods
Method(s): We collected dose predictions for head-and-neck cancer radiotherapy from 21 different research groups internationally who participated in the OpenKBP Grand Challenge. Each research group used the same training dataset (n=200) and validation dataset (n=40) to develop their methods. These methods predicted dose on a testing dataset (n=100), and those 2100 unique dose predictions were input to a previously published plan optimization method to generate 2100 treatment plans. The predictions and plans were compared to the ground truth dose via: (1)error, the mean absolute voxel-by-voxel difference in dose; and (2) quality, the mean and maximum deviation across 23 dose-volume histogram (DVH) criteria.
Result(s): The range in median prediction error among the top 20 methods was 2.3Gy to 12.0Gy, which was 6.8Gy wider than the range in median plan error of 2.1Gy to 5.0Gy. One method also achieved significantly lower prediction error (P<0.05; one-sided Wilcoxon test) than all the other methods, however, it generated plans with error that was not significantly lower than 28.6% of the other methods. Additionally, predicted dose was consistently lower quality than plan dose. Half (n=1050) of all predictions and plans had an average deviation that was 0.1Gy worse and 0.8Gy better than the ground truth dose, respectively. Similarly, half of all predictions had a maximum deviation that was 3.7Gy worse than the ground truth dose, which was 1.0Gy worse than half of all plans.
Conclusion(s): Many dose prediction methods can achieve low error, however, optimization often improves upon the predictions and eliminates significant differences between prediction methods. Thus, it is critical that we improve the optimization stage in KBP to get better utility out of the existing high-quality dose prediction methods
EMBASE:635752412
ISSN: 0094-2405
CID: 4986252
Dynamics of minimal residual disease in patients with multiple myeloma on continuous lenalidomide maintenance: a single-arm, single-centre, phase 2 trial
Background Lenalidomide maintenance improves progression-free survival for patients with multiple myeloma, although its optimal duration is unknown. Clearance of minimal residual disease (MRD) in the bone marrow results in superior outcomes, although its attainment or sustainment does not alter clinical decision-making. Studies that have evaluated MRD serially are limited in length. We therefore aimed to evaluate longitudinal changes in MRD-status (dynamics) and their association with progression-free survival in patients with multiple myeloma.
PMID: 34048681
ISSN: 2352-3026
CID: 4888422
Mapping the Clinical Experience of a New York City Residency Program During the COVID-19 Pandemic
The COVID-19 pandemic has dramatically disrupted the educational experience of medical trainees. However, a detailed characterization of exactly how trainees' clinical experiences have been affected is lacking. Here, we profile residents' inpatient clinical experiences across the four training hospitals of NYU's Internal Medicine Residency Program during the pandemic's first wave. We mined ICD-10 principal diagnosis codes attributed to residents from February 1, 2020, to May 31, 2020. We translated these codes into discrete medical content areas using a newly developed "crosswalk tool." Residents' clinical exposure was enriched in infectious diseases (ID) and cardiovascular disease content at baseline. During the pandemic's surge, ID became the dominant content area. Exposure to other content was dramatically reduced, with clinical diversity repopulating only toward the end of the study period. Such characterization can be leveraged to provide effective practice habits feedback, guide didactic and self-directed learning, and potentially predict competency-based outcomes for trainees in the COVID era.
PMCID:8191765
PMID: 34129487
ISSN: 1553-5606
CID: 4911612
Sustained Benefit of Alternate Behavioral Interventions to Improve Hypertension Control: A Randomized Clinical Trial
[Figure: see text].
PMID: 33979183
ISSN: 1524-4563
CID: 4864532
A Community Health Worker-Led Intervention to Improve Blood Pressure Control in an Immigrant Community With Comorbid Diabetes: Data From Two Randomized, Controlled Trials Conducted in 2011-2019
Evidence-based strategies addressing comorbid hypertension and diabetes are needed among minority communities. We analyzed the outcome of blood pressure (BP) control using pooled data from two community health worker interventions in New York City conducted between 2011 and 2019, focusing on participants with comorbid hypertension and diabetes. The adjusted odds of controlled BP (< 140/90 mmHg) for the treatment group were significant compared with the control group (odds ratio = 1.4; 95% confidence interval = 1.1, 1.8). The interventions demonstrated clinically meaningful reductions in BP among participants with comorbid hypertension and diabetes.
PMCID:8101563
PMID: 33950735
ISSN: 1541-0048
CID: 4874042
