Faculty Bibliography

New York City has been described as the epicenter of the COVID-19 pandemic in the United States. While health care workers are notably at increased risk for COVID-19 infection, the impact on resident physicians remains unclear. In this issue of the JCI, Breazzano et al. surveyed resident physicians for their exposure to COVID-19 during the exponential phase of the COVID-19 pandemic. The researchers also assessed how personal protective equipment (PPE) and COVID-19 testing protected health care workers (HCWs) from infection. This study highlights resident physician experiences of the first COVID-19 wave that can inform and improve preparedness for upcoming COVID-19 surges and other future epidemics.

The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Myeloma Intergroup has organized an annual workshop focused on minimal residual disease (MRD) testing and immune profiling (IP) in multiple myeloma since 2016. In 2019, the workshop took place as an American Society of Hematology (ASH) Friday Scientific Workshop entitled "Immune Profiling and Minimal Residual Disease Testing in Multiple Myeloma". This workshop focused on four main topics: the molecular and immunological evolution of plasma cell disorders, the development of new laboratory- and imaging-based MRD assessment approaches, chimeric antigen receptor T-cell therapy research, and the statistical and regulatory issues associated with novel clinical endpoints. In this report, we provide a summary of the workshop and discuss future directions.

PURPOSE/OBJECTIVE:The purpose of our research is to evaluate the usefulness of chest X-ray for triaging patients with suspected COVID-19 infection. METHODS:IRB approval was obtained to allow a retrospective review of adult patients who presented to the Emergency Department with a complaint of fever, cough, dyspnea or hypoxia and had a chest X-ray between 12 March 2020 and 26 March 2020. The initial chest X-ray was graded on a scale of 0-3 with grade 0 representing no alveolar opacities, grade 1: < 1/3 alveolar opacities of the lung, Grade 2: 1/3 to 2/3 lung with alveolar opacities and grade 3: > 2/3 alveolar opacities of the lung. Past medical history of diabetes and hypertension, initial oxygen saturation, COVID-19 testing results, intubation, and outcome were also collected. RESULTS:Four hundred ten patient chest X-rays were reviewed. Oxygen saturation and X-ray grade were both significantly associated with the length of stay in hospital, the hazard ratio (HR) of discharge was 1.05 (95% CI [1.01, 1.09], p = 0.017) and 0.61 (95% CI [0.51, 0.73], p < 0.001), respectively. In addition, oxygen saturation and X-ray grade were significant predictors of intubation (odds ratio (OR) of intubation is 0.88 (95% CI [0.81, 0.96], p = 0.004) and 3.69 (95% CI [2.25, 6.07], p < 0.001). CONCLUSIONS:Initial chest X-ray is a useful tool for triaging those subjects who might have poor outcomes with suspected COVID-19 infection and benefit most from hospitalization.

IMPORTANCE/OBJECTIVE:New York City is a global epicenter for the SARS-CoV-2 outbreak with a significant number of individuals infected by the virus. Patients with multiple myeloma have a compromised immune system, due to both the disease and anti-myeloma therapies, and may therefore be particularly susceptible to coronavirus disease 2019 (COVID-19); however, there is limited information to guide clinical management. OBJECTIVE:To assess risk factors and outcomes of COVID-19 in patients with multiple myeloma. DESIGN/METHODS:Case-series. SETTING/METHODS:Five large academic centers in New York City. PARTICIPANTS/METHODS:Patients with multiple myeloma and related plasma cell disorders who were diagnosed with COVID-19 between March 10th, 2020 and April 30th, 2020. Exposures: Clinical features and risk factors were analyzed in relation to severity of COVID-19. Main Outcomes and Measures: Descriptive statistics as well as logistic regression were used to estimate disease severity reflected in hospital admissions, intensive care unit (ICU) admission, need for mechanical ventilation, or death. RESULTS:Of 100 multiple myeloma patients (male 58%; median age 68, range 41-91) diagnosed with COVID-19, 74 (74%) were admitted; of these 13 (18%) patients were placed on mechanical ventilation, and 18 patients (24%) expired. None of the studied risk factors were significantly associated (P>0.05) with adverse outcomes (ICU-admission, mechanical ventilation, or death): hypertension (N=56) odds ratio (OR) 2.3 (95% confidence interval [CI] 0.9-5.9); diabetes (N=18) OR 1.1 (95% CI 0.3-3.2); age >65 years (N=63) OR 2.0 (95% CI 0.8-5.3); high dose melphalan with autologous stem cell transplant <12 months (N=7) OR 1.2 (95% CI 0.2-7.4), IgG<650 mg/dL (N=42) OR=1.2 (95% CI 0.4-3.1). In the entire series of 127 patients with plasma cell disorders, hypertension was significantly associated with the combined end-point (OR 3.4, 95% CI 1.5-8.1). CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Although multiple myeloma patients have a compromised immune system due to both the disease and therapy; in this largest disease specific cohort to date of patients with multiple myeloma and COVID-19, compared to the general population, we found risk factors for adverse outcome to be shared and mortality rates to be within the higher range of officially reported mortality rates.

BACKGROUND/PURPOSE/OBJECTIVE:In previously published work, atherosclerotic vascular events (AVE) occurred in approximately 10% of patients with SLE. We aimed to investigate the annual occurrence and potential risk factors for AVE in a multinational, multiethnic inception cohort of patients with SLE. METHODS:A large 33-centre cohort of SLE patients was followed yearly between 1999-2017. AVEs were attributed to atherosclerosis on the basis of SLE being inactive at the time of the AVE, and typical atherosclerotic changes on imaging or pathology, and/or evidence of atherosclerosis elsewhere. Analysis included descriptive statistics, rate of AVE's per 1000 patient-years, and univariable and multivariable relative risk regression models. RESULTS:Of the 1848 patients enrolled in the cohort, 1710 had at least one follow up visit after enrolment, for a total of 13,666 patient-years. Of 1710, 3.6% had one or more AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarials (HR: 0.54[95% CI 0.32, 0.91]) while higher AVE rates were associated with any prior vascular event (VE) (HR: 4.00[1.55,10.30]) and body mass index (BMI) >40 (HR: 2.74[1.04,7.18]) A prior AVE increased the risk for subsequent AVE (HR 5.42[3.17,9.27], p<0.001). CONCLUSION/CONCLUSIONS:The prevalence of AVE and rate of AVE accrual in this study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.

Ascending to the peak of the novel coronavirus disease (COVID-19) pandemic in New York City, NYC Health + Hospitals (NYC H+H), the City's public health care system, rapidly expanded capacity across its 11 acute-care hospitals and three new field hospitals. To meet the unprecedented demand for patient care, NYC H+H redeployed staff to the areas of greatest need and redesigned recruiting, onboarding, and training processes. The hospital system engaged private staffing agencies, partnered with the U.S Department of Defense, and recruited volunteers throughout the country. A centralized onboarding team created a single-source portal for medical providers requiring credentialing and established new staff positions to increase efficiency. Using new educational tools focused on COVID-19 content, the hospital system trained 20,000 staff, including nearly 9,000 nurses, within a two-month period. Creation of multidisciplinary teams, frequent enterprise-wide communication, willingness to shift direction in response to changing needs, and innovative use of technology were the key factors that enabled the hospital system to meet its goals. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].

BACKGROUND/UNASSIGNED:Health care specialty organizations are an important resource for their membership; however, it is not clear how specialty societies should approach combating stress and burnout on an organizational scale. OBJECTIVE/UNASSIGNED:To understand the prevalence of burnout syndrome in American Thoracic Society members, identify specialty-specific risk factors, and generate strategies for health care societies to combat burnout. METHODS/UNASSIGNED:Cross-sectional, mixed-methods survey in a sample of 2018 American Thoracic Society International Conference attendees to assess levels of burnout syndrome, work satisfaction, and stress. RESULTS/UNASSIGNED:Of the 130 respondents, 69% reported high stress, 38% met burnout criteria, and 20% confirmed chaotic work environments. Significant associations included sex and stress level; clinical time and at-home electronic health record work; and US practice and at-home electronic health record work. There were no significant associations between burnout syndrome and the selected demographics. Participants indicated patient care as the most meaningful aspect of work, whereas the highest contributors to burnout were workload and electronic health record documentation. Importantly, most respondents were unaware of available resources for burnout. CONCLUSIONS/UNASSIGNED:Health care specialty societies have access to each level of the health system, creating an opportunity to monitor trends, disseminate resources, and influence the direction of efforts to reduce workplace stress and enhance clinician well-being.

Understanding how previous experiences with interprofessional education and collaboration inform health care provider perspectives is important for developing interprofessional interventions at the graduate level. The purpose of this study was to examine how previous work experiences of graduate level health professions students inform perspectives about interprofessional education and collaboration. Drawing from program evaluation data of two separate graduate level interprofessional education interventions based in primary care and home health care, we conducted a qualitative secondary data analysis of 75 interviews generated by focus groups and individual interviews with graduate students from 4 health professions cadres. Using directed content analysis, the team coded to capture descriptions of interprofessional education or collaboration generated from participants' previous work experiences. Coding revealed 173 discrete descriptions related to previous experiences of interprofessional education or collaboration. Three themes were identified from the analysis that informed participant perspectives: Previous educational experiences (including work-based training); previous work experiences; and organizational factors and interprofessional collaboration. Experiences varied little between professions except when aspects of professional training created unique circumstances. The study reveals important differences between graduate and undergraduate learners in health professions programs that can inform interprofessional education and collaboration intervention design.

Hypertension is a risk factor for cardiovascular disease, which is the leading cause of death in the United States. Taxi and for-hire vehicle (FHV) drivers, a largely male, immigrant and medically underserved population, are at increased risk of cardiovascular disease, in part due to the nature of their work. This study examined demographic and lifestyle predictors of hypertension diagnosis awareness, objectively measured blood pressure (hypertensive-range vs non-hypertensive-range readings), medication use, and hypertension control. A cross-sectional assessment was conducted with 983 male taxi/FHV drivers who attended health fairs in New York City from 2010 to 2017. Twenty-three percent self-reported a hypertension history and 46% had hypertensive-range BP readings. Approximately, half the drivers lacked health insurance (47%) and a usual care source (46%). Thirty percent did not self-report hypertension and had hypertensive-range BP readings. Medication use was reported by 69% of hypertension-aware drivers, and being older and having health care access (insurance, a usual care source, and seeing a doctor in the past year) was significantly associated with medication use. Hypertension-unaware drivers with hypertensive-range BP readings were less likely to have a usual care source. Over 60% of drivers who were hypertension-aware and on medication had hypertensive-range readings. There is a need for community-based and workplace driver and provider interventions to address BP awareness and management and to provide health care navigation for vulnerable populations such as taxi/FHV vehicle drivers.