Faculty Bibliography

BACKGROUND/UNASSIGNED:Myocardial injury detected after percutaneous coronary intervention (PCI) is associated with increased mortality. Predictors of post-PCI myocardial injury are not well established. The long-term prognostic relevance of post-PCI myocardial injury remains uncertain. METHODS/UNASSIGNED:Consecutive adults aged ≥18 years with stable ischemic heart disease who underwent elective PCI at NYU Langone Health between 2011 and 2020 were included in a retrospective, observational study. Patients with acute myocardial infarction or creatinine kinase myocardial band (CKMB) or troponin concentrations >99% of the upper reference limit before PCI were excluded. All patients had routine measurement of CKMB concentrations at 1 and 3 hours post-PCI. Post-PCI myocardial injury was defined as a peak CKMB concentration >99% upper reference limit. Linear regression models were used to identify clinical factors associated with post-PCI myocardial injury. Cox proportional hazard models were generated to evaluate relationships between post-PCI myocardial injury and all-cause mortality at long-term follow-up. RESULTS/UNASSIGNED:<0.001). After adjustment for demographics and clinical covariates, post-PCI myocardial injury was associated with an excess hazard for long-term mortality (hazard ratio, 1.46 [95% CI, 1.20-1.78]). CONCLUSIONS/UNASSIGNED:Myocardial injury defined by elevated CKMB early after PCI is common and associated with all-cause, long-term mortality. More complex coronary anatomy is predictive of post-PCI myocardial injury.

OBJECTIVE:This study examined associations between access to leisure-time physical activity (LTPA) facilities and parks and repeated measures of glycated hemoglobin (A1C) over time, using follow-up tests among United States Veterans with newly diagnosed type-2 diabetes (T2D). METHODS:Data were analyzed from 274,463 patients in the Veterans Administration Diabetes Risk cohort who were newly diagnosed with T2D between 2008 and 2018 and followed through 2023. Generalized estimating equations with a logit link function and binomial logistic regression were used to examine associations. RESULTS:Patients were on average 60.5 years of age, predominantly male (95.0 %) and white (66.9 %), and had an average of 11.7 A1C tests during the study follow-up period. In high- and low-density urban communities, a one-unit higher LTPA facility density score was associated with 1 % and 3 % greater likelihood of in-range A1C tests during follow-up, respectively, but no association was observed among patients living in suburban/small town and rural communities. Across community types, closer park distance was not associated with subsequent greater odds of in-range A1C tests. Unexpectedly, in low-density urban areas, the likelihood of in-range A1C tests was 1 % lower at farther park distances. CONCLUSIONS:These results suggest that broader access to LTPA facilities, but not park proximity, may contribute in small ways to maintaining glycemic control after T2D diagnosis in urban communities. Tailored interventions may be needed to promote patients' effective use of LTPA facilities and parks.

BACKGROUND:Clinical reasoning (CR) is an essential skill; yet, physicians often receive limited feedback. Artificial intelligence holds promise to fill this gap. OBJECTIVE:We report the development of named entity recognition (NER), logic-based and large language model (LLM)-based assessments of CR documentation in the electronic health record across 2 institutions (New York University Grossman School of Medicine [NYU] and University of Cincinnati College of Medicine [UC]). METHODS:-scores for the NER, logic-based model and area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) for the LLMs. RESULTS:-scores 0.80, 0.74, and 0.80 for D0, D1, D2, respectively. The GatorTron LLM performed best for EA2 scores AUROC/AUPRC 0.75/ 0.69. CONCLUSIONS:This is the first multi-institutional study to apply LLMs for assessing CR documentation in the electronic health record. Such tools can enhance feedback on CR. Lessons learned by implementing these models at distinct institutions support the generalizability of this approach.

Minoritized communities often experience worse health outcomes on the cancer continuum. Mainstream strategies may have limited reach and utility to populations experiencing inequities in real-world settings. Through the combined use of community-based participatory research (CBPR) and social marketing strategies, which highlight community-centered and culturally adapted processes, we provide an approach to inform future intervention research across various health topics that has been successful in engaging minoritized and understudied communities. We present two case studies that used participatory social marketing principles to culturally adapt evidence-based cancer screening programs for two communities in New York City. The first program is a campaign to increase screening and vaccination for hepatitis B among Korean and Chinese American immigrants. The second is a culturally adapted program to increase breast and cervical cancer screening among a multiracial and ethnic population of Muslim women. These case studies illustrate the benefits of integrating social marketing and CBPR approaches as a key strategy when developing public health campaigns to effectively reach and influence health behaviors in partnership with communities that have been socially marginalized and historically underserved.

BACKGROUND:Hepatic artery infusion with floxuridine is a treatment option for patients with colorectal liver metastases or intrahepatic cholangiocarcinoma. Outcomes from newer centers are understudied. Predictive markers are needed, and quantitative circulating tumor DNA is an emerging candidate method for predicting response in patients receiving hepatic artery infusion. We aimed to describe safety, feasibility, early oncologic outcomes, and quantitative circulating tumor DNA dynamics in patients treated with hepatic artery infusion at a newly established program. METHODS:Single-institution analysis of patients who underwent hepatic artery infusion pump placement (April 2022-April 2024) was conducted. Primary outcomes included safety and feasibility (receiving ≥1 cycle of floxuridine). Secondary outcomes included radiographic response (Response Evaluation Criteria in Solid Tumors 1.1), relative dose intensity of floxuridine received, and quantitative circulating tumor DNA response. RESULTS:A total of 36 patients underwent hepatic artery infusion pump placement (colorectal liver metastases: 32; cholangiocarcinoma: 4). Technical success was 100%. Feasibility was 97%. One patient experienced mortality at 90 days from disease progression. Three patients (8%) experienced a total of 5 hepatic artery infusion pump-specific complications (pump pocket [n = 3], hemorrhage [n = 1], biliary sclerosis [n = 1]). Median relative dose intensity was 68.5% (colorectal liver metastases: 68.3%; cholangiocarcinoma 72.5.0%). For the 27 patients who underwent floxuridine therapy with available postoperative imaging, disease control rate was 97% (partial response: n = 15; stable disease: n = 11). Quantitative circulating tumor DNA was obtained from 16 patients (44%). Circulating tumor DNA dynamics appeared to correlate with and precede radiographic response. CONCLUSIONS:Implementation of a new hepatic artery infusion program is safe and feasible with promising early oncologic outcomes. Circulating tumor DNA tracking is achievable and dynamic changes in circulating tumor DNA may correlate with radiographic response to treatment.

BACKGROUND/UNASSIGNED:COVID-19 has caused over 46,000 deaths in New York City, with a disproportional impact on certain communities. As part of the COVID-19 response, the city has directly administered over 6 million COVID-19 tests (in addition to millions of indirectly administered tests not covered in this analysis) at no cost to individuals, resulting in nearly half a million positive results. Given that the prevalence of testing, throughout the pandemic, has tended to be higher in more affluent areas, these tests were targeted to areas with fewer resources. OBJECTIVE/UNASSIGNED:This study aimed to evaluate the impact of New York City's COVID-19 testing program; specifically, we aimed to review its ability to provide equitable testing in economically, geographically, and demographically diverse populations. Of note, in addition to the brick-and-mortar testing sites evaluated herein, this program conducted 2.1 million tests through mobile units to further address testing inequity. METHODS/UNASSIGNED:Testing data were collected from the in-house Microsoft SQL Server Management Studio 18 Clarity database, representing 6,347,533 total tests and 449,721 positive test results. These tests were conducted at 48 hospital system locations. Per capita testing rates by zip code tabulation area (ZCTA) and COVID-19 positivity rates by ZCTA were used as dependent variables in separate regressions. Median income, median age, the percentage of English-speaking individuals, and the percentage of people of color were used as independent demographic variables to analyze testing patterns across several intersecting identities. Negative binomial regressions were run in a Jupyter Notebook using Python. RESULTS/UNASSIGNED:Per capita testing inversely correlated with median income geographically. The overall pseudo r2 value was 0.1101 when comparing hospital system tests by ZCTA against the selected variables. The number of tests significantly increased as median income fell (SE 1.00000155; P<.001). No other variables correlated at a significant level with the number of tests (all P values were >.05). When considering positive test results by ZCTA, the number of positive test results also significantly increased as median income fell (SE 1.57e-6; P<.001) and as the percentage of female residents fell (SE 0.957; P=.001). The number of positive test results by ZCTA rose at a significant level alongside the percentage of English-only speakers (SE 0.271; P=.03). CONCLUSIONS/UNASSIGNED:New York City's COVID-19 testing program was able to improve equity through the provision of no-cost testing, which focused on areas of the city that were disproportionately impacted by COVID-19 and had fewer resources. By detecting higher numbers of positive test results in resource-poor neighborhoods, New York City was able to deploy additional resources, such as those for contact tracing and isolation and quarantine support (eg, free food delivery and free hotel stays), early during the COVID-19 pandemic. Equitable deployment of testing is feasible and should be considered early in future epidemics or pandemics.

BACKGROUND:Clinical use of continuous glucose monitoring (CGM) is increasing storage of CGM-related documents in electronic health records (EHR); however, the standardization of CGM storage is lacking. We aimed to evaluate the sensitivity and specificity of CGM Ambulatory Glucose Profile (AGP) classification criteria. METHODS:We randomly chose 2244 (18.1%) documents from NYU Langone Health. Our document classification algorithm: (1) separated multiple-page documents into a single-page image; (2) rotated all pages into an upright orientation; (3) determined types of devices using optical character recognition; and (4) tested for the presence of particular keywords in the text. Two experts in using CGM for research and clinical practice conducted an independent manual review of 62 (2.8%) reports. We calculated sensitivity (correct classification of CGM AGP report) and specificity (correct classification of non-CGM report) by comparing the classification algorithm against manual review. RESULTS:Among 2244 documents, 1040 (46.5%) were classified as CGM AGP reports (43.3% FreeStyle Libre and 56.7% Dexcom), 1170 (52.1%) non-CGM reports (eg, progress notes, CGM request forms, or physician letters), and 34 (1.5%) uncertain documents. The agreement for the evaluation of the documents between the two experts was 100% for sensitivity and 98.4% for specificity. When comparing the classification result between the algorithm and manual review, the sensitivity and specificity were 95.0% and 91.7%. CONCLUSION/CONCLUSIONS:Nearly half of CGM-related documents were AGP reports, which are useful for clinical practice and diabetes research; however, the remaining half are other clinical documents. Future work needs to standardize the storage of CGM-related documents in the EHR.

IMPORTANCE/UNASSIGNED:Health-related social needs (HRSN) influence health outcomes and health care utilization. Clinicians face challenges addressing HRSN due to limited skills, expertise, and time. Further insight is needed on how patients and clinicians navigate HRSN in clinical encounters. OBJECTIVE/UNASSIGNED:This study examines outpatient primary care encounters predating widespread HRSN screening to identify how discussions on HRSN are initiated and addressed. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This qualitative analysis was conducted on transcripts of 97 audiotaped English-speaking patient encounters from 3 clinics in New York City within a municipal health care system from January 2011 through April 2015. Patients were eligible if they were older than 18 years, self-identified as Black or White, had a diagnosis of hypertension, and had at least one prior encounter with the participating clinician. Codes were developed from social needs domains addressed by the Accountable Health Communities HRSN Screening Tool. Codes were added for further social needs identified, whether a patient or clinician initiated the HRSN discussion, and how a social need was addressed, if at all. Encounters were analyzed between June 2023 and February 2024. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Characterization of the content and nature of HRSN discussions during clinical encounters within safety-net clinics. RESULTS/UNASSIGNED:A total of 97 patients (55 [56.7%] women, 58 [59.8%] Black, mean [SD] age, 59.7 [10.6] years) had audiotaped encounters with 27 clinicians (18 [66.7%] women, 15 [55.6%] White, mean [SD] age, 36 [5.8] years). Physical activity (36% of encounters), financial strain (35%), mental health (34%), and substance use (28%) were the most discussed HRSN domains across the 97 encounters. Patients introduced financial strain most often (70% of the time), while clinicians led substance use (75%), physical activity (51%) and mental health (51%) discussions. Patients initiated conversations on employment (77%), food insecurity (62%), and housing instability (52%). Interventions included prescriptions, forms, counseling, and referrals. Domains frequently intervened on included health care navigation needs (85% of discussions), substance use (33%), and mental health (27%). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this qualitative study of HRSN discussions in primary care encounters, clinicians were more likely to initiate discussions on substance use, physical activity, and mental health, behaviors routinely assessed in primary care, but different from topics introduced by patients. Findings underscore the need for standardized screening to improve identification of domains less frequently addressed by clinicians. Additional interventions are also needed, including clinician training for how to address HRSN in resource-constrained settings and integration of other health care team members, to enhance HRSN identification and intervention.