Faculty Bibliography

The objective of this study was to establish recommendations for thromboprophylaxis in patients with endogenous Cushing's syndrome (CS), addressing the elevated risk of venous thromboembolism (VTE) associated with hypercortisolism. A Delphi method was used, consisting of 4 rounds of voting and subsequent discussions. The panel included 18 international experts from 11 countries and 4 continents. Consensus was defined as ≥75% agreement among participants. Recommendations were structured into the following categories: thromboprophylaxis, perioperative management, and VTE treatment. Consensus was reached on several critical areas, resulting in 14 recommendations. Key recommendations include: thromboprophylaxis should be considered at time of CS diagnosis and continued for 3 months after biochemical remission, provided there are no obvious contraindications. The standard weight-based prophylactic dose of low molecular-weight heparin is the preferred agent for thromboprophylaxis in patients with CS. Additionally, perioperatively and around inferior petrosal sinus sampling, thromboprophylaxis should be reconsidered if not already initiated at diagnosis. For VTE treatment, extended thromboprophylaxis is advised continuing for 3 months after Cushing is resolved. These Delphi consensus-based recommendations aim to standardize care practices and enhance patient outcomes in CS by providing guidance on thromboprophylaxis, including its initiation and continuation across various disease states, as well as the preferred agents to use. The panel also highlighted key areas for further research, particularly regarding the use of direct oral anticoagulants in CS and the management of mild CS and mild autonomous cortisol secretion. Additionally, the optimal duration of anticoagulant prophylaxis following curative treatment remains uncertain.

PURPOSE/OBJECTIVE:World Trade Center (WTC) rescue/recovery workers were exposed to materials hazardous to health. Previous studies found lower than expected mortality among WTC rescue/recovery workers when compared to general populations, possibly due to healthy worker effects, better healthcare access and/or incomparability of the groups. We compared mortality rates in WTC-exposed law enforcement officers (LEOs) with rates in LEOs employed by the Buffalo, NY, Police Department. We also compared both cohorts to the general population. METHODS:Follow-up began at the later of one year after enrollment date or 1/1/2005 and ended at the earlier of death date or 12/31/2018. Analyses were restricted to ages 40-79 years (N = 11,476 WTC LEOs, N = 1668 non-WTC LEOs). We estimated standardized mortality ratios (SMRs) in each cohort using stratum-specific US mortality rates. Relative rates (RRs) and 95% CIs were estimated for the WTC vs. the Buffalo cohort using Poisson regression models adjusted for sex, race, age-group, and calendar-period. RESULTS:185 deaths were observed in the WTC cohort and 186 in the Buffalo cohort. All-cause and cause-specific SMRs were significantly lower in the WTC cohort. Similarly, the adjusted all-cause mortality RR for the WTC vs. Buffalo cohorts was 0.30 (95% CI = 0.23-0.40). The cause-specific mortality RRs were all significantly < 1. CONCLUSION/CONCLUSIONS:We found lower overall and cause-specific mortality rates in WTC LEOs compared with both the general population and Buffalo LEOs. These results suggest that factors other than healthy worker effects, such as access to healthcare via the WTC Health Program, contribute to lower mortality rates in WTC rescue/recovery workers.

OBJECTIVE:To explore how Sesame Workshop resources are perceived by Latino families with economic hardship and to highlight approaches for early heart healthy routine promotion. METHODS:We performed a purposive sampling of Latina mothers (n = 40) with young children experiencing economic hardship. Using an interview guide informed by the Consolidated Framework for Implementation Research, we recorded Spanish and English semistructured interviews, which were translated and transcribed verbatim. Partnering with Sesame Workshop, we iteratively incorporated Sesame Resources into interviews to query for acceptability. Using reflexive thematic analysis, we coded transcripts through textual analysis until saturation, prioritizing in vivo coding to capture participant voices. RESULTS:We constructed 3 themes. Parents connected with resources that 1) Reflect lived and multicultural experiences containing recognizable family scenes that can serve as tools to transfer a parent's own early routines or cultural rituals to their child. They appreciated resources that 2) Engage caregivers and children together, featuring elements for both children and adult caregivers with activities to highlight important caregivers and encourage shared play. Participants also reflected on how 3) Routines amplify family strengths and foster resilient reactions with feelings of decreased stress when daily practices become routines, promoting resilient reactions and supporting long-term goals when facing setbacks. CONCLUSIONS:An interdisciplinary partnership leveraged strengths of pediatric practitioners and Sesame Workshop to align future initiatives with the values and priorities of mothers of young children at risk for early obesity. Resultant themes inform strategies to promote heart healthy routines and relational health in young children with economic hardship.

AIM/OBJECTIVE:To describe the self-reported mental health of nurses from 35 countries who worked during the COVID-19 pandemic. BACKGROUND:There is little occupationally specific data about nurses' mental health worldwide. Studies have documented the impact on nurses' mental health of the COVID-19 pandemic, but few have baseline referents. METHODS:A descriptive, cross-sectional design structured the study. Data reflect a convenience sample of 9,387 participants who completed the opt-in survey between July 31, 2022, and October 31, 2023. Descriptive statistics were run to analyze the following variables associated with mental health: Self-reports of mental health symptoms, burnout, personal losses during the pandemic, access to mental health services, and self-care practices used to cope with pandemic-related stressors. Reporting of this study was steered by the STROBE guideline for quantitative studies. RESULTS:Anxiety or depression occurred at rates ranging from 23%-61%, with country-specific trends in reporting observed. Approximately 18% of the sample reported experiencing some symptoms of burnout. The majority of nurses' employers did not provide mental health support in the workplace. Most reported more frequently engaging with self-care practices compared with before the pandemic. Notably, 20% of nurses suffered the loss of a family member, 35% lost a friend, and 34% a coworker due to COVID-19. Nearly half (48%) reported experiencing public aggression due to their identity as a nurse. CONCLUSIONS:The data obtained establish a basis for understanding the specific mental health needs of the nursing workforce globally, highlighting key areas for service development. IMPLICATIONS FOR NURSING POLICY/CONCLUSIONS:Healthcare organizations and governmental bodies need to develop targeted mental health support programs that are readily accessible to nurses to foster a resilient nursing workforce.

BACKGROUND/UNASSIGNED:Usability testing is valuable for assessing a new tool or system's usefulness and ease-of-use. Several established methods of usability testing exist, including think-aloud testing. Although usability testing has been shown to be crucial for successful clinical decision support (CDS) tool development, it is often difficult to conduct across multisite development projects due to its time- and labor-intensiveness, cost, and the skills required to conduct the testing. OBJECTIVE/UNASSIGNED:Our objective was to develop a new method of usability testing that would enable efficient acquisition and dissemination of results among multiple sites. We sought to address the existing barriers to successfully completing usability testing during CDS tool development. METHODS/UNASSIGNED:We combined individual think-aloud testing and focus groups into one session and performed sessions serially across 4 sites (snowball group usability testing) to assess the usability of two CDS tools designed for use by nurses in primary and urgent care settings. We recorded each session and took notes in a standardized format. Each site shared feedback from their individual sessions with the other sites in the study so that they could incorporate that feedback into their tools prior to their own testing sessions. RESULTS/UNASSIGNED:The group testing and snowballing components of our new usability testing method proved to be highly beneficial. We identified 3 main benefits of snowball group usability testing. First, by interviewing several participants in a single session rather than individuals over the course of weeks, each site was able to quickly obtain their usability feedback. Second, combining the individualized think-aloud component with a focus group component in the same session helped study teams to more easily notice similarities in feedback among participants and to discuss and act upon suggestions efficiently. Third, conducting usability testing in series across sites allowed study teams to incorporate feedback based on previous sites' sessions prior to conducting their own testing. CONCLUSIONS/UNASSIGNED:Snowball group usability testing provides an efficient method of obtaining multisite feedback on newly developed tools and systems, while addressing barriers typically associated with traditional usability testing methods. This method can be applied to test a wide variety of tools, including CDS tools, prior to launch so that they can be efficiently optimized.

OBJECTIVES/OBJECTIVE:The study aimed to assess the usage and impact of a private and secure instance of a generative artificial intelligence (GenAI) application in a large academic health center. The goal was to understand how employees interact with this technology and the influence on their perception of skill and work performance. MATERIALS AND METHODS/METHODS:New York University Langone Health (NYULH) established a secure, private, and managed Azure OpenAI service (GenAI Studio) and granted widespread access to employees. Usage was monitored and users were surveyed about their experiences. RESULTS:Over 6 months, over 1007 individuals applied for access, with high usage among research and clinical departments. Users felt prepared to use the GenAI studio, found it easy to use, and would recommend it to a colleague. Users employed the GenAI studio for diverse tasks such as writing, editing, summarizing, data analysis, and idea generation. Challenges included difficulties in educating the workforce in constructing effective prompts and token and API limitations. DISCUSSION/CONCLUSIONS:The study demonstrated high interest in and extensive use of GenAI in a healthcare setting, with users employing the technology for diverse tasks. While users identified several challenges, they also recognized the potential of GenAI and indicated a need for more instruction and guidance on effective usage. CONCLUSION/CONCLUSIONS:The private GenAI studio provided a useful tool for employees to augment their skills and apply GenAI to their daily tasks. The study underscored the importance of workforce education when implementing system-wide GenAI and provided insights into its strengths and weaknesses.

Up to 30% of adrenocortical carcinoma (ACC) patients have metastasised disease upon initial presentation, and systemic treatments currently fail to sufficiently improve survival. Palliative primary tumour resection can be considered for symptomatic relief, but its potential survival benefit remains a topic of debate. This systematic review therefore aims to assess the effect of primary tumour resection on overall survival in patients with metastatic ACC. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant databases were searched from 2000 to 2024 for studies on primary tumour resection in metastatic ACC. Overall survival data were analysed. A total of 13 studies on primary tumour resection for metastatic ACC were included. All studies were retrospective and assessed as having a high risk of bias. Data regarding adequate patient characteristics and indications for surgery were missing in all studies. Hence, the current literature is hampered by both indication and selection biases to draw any conclusions on the survival benefit of primary tumour resection in patients with metastasised ACC. However, 12 out of 13 studies (92%) demonstrated longer overall survival after primary tumour resection compared to no surgery. Whereas this is in line with retrospective data on other cancers, randomised controlled trials in other tumours, such as breast and colorectal cancers, have failed to display survival benefits of primary tumour resection. These cancers are, however, relatively chemo-sensitive, unlike ACC. Primary tumour resection could therefore only be considered on an individual patient basis.

INTRODUCTION/UNASSIGNED:Given the significant interindividual variable responses to interventions for obesity, the early identification of factors associated with a differential in weight loss would benefit real-world approaches in clinical practice. OBJECTIVE/UNASSIGNED:This study evaluated the factors associated with individual variability in response to enrolling in a weight management program integrated into an academic-based primary care practice. METHODS/UNASSIGNED:Data were retrospectively collected and analyzed for patients referred to a primary care-based weight management practice between 2012 and 2020. A mixed-model, semi-parametric group-based modeling approach was used to identify group membership and explore weight change trajectories over 18 months, as measured by the percent of initial body weight loss and the probability of losing at least 5% of initial body weight (IBW). RESULTS/UNASSIGNED:Younger age, non-Hispanic Black race, fewer follow-up visits, and lower proportion prescribed two or more anti-obesity medications (AOMs) simultaneously were associated with a lower probability of achieving 5% IBW. CONCLUSIONS/UNASSIGNED:Compared to the other groups, Weight Gainers and Minimal Late Responders had a distinct trajectory associated with two modifiable factors: the number of treatment visits and AOMs. Tailored interventions targeting these factors early may increase the probability of meaningful weight loss.