Faculty Bibliography

Introduction/UNASSIGNED:Few treatments have demonstrated mortality benefits among hospitalized hypoxic COVID-19 patients. We evaluated the use of hyperbaric oxygen (HBO2) therapy as a therapeutic intervention among hospitalized patients with a high oxygen requirement prior to vaccine approval. Methods/UNASSIGNED:We extracted data on patients with COVID-19 hypoxia who required oxygen supplementation ranging from a 6L nasal cannula up to a high-flow nasal cannula at 100% FiO2 at 60L/minute with a 100% non-rebreather mask at 15 L/minute and were eligible for off-label HBO2 therapy from October 2020 to February 2021. We followed the Monitored Emergency use of Unregistered and Investigational Interventions or (MEURI) in conjunction with the consistent re-evaluation of the protocol using the Plan-Do-Study-Act (PDSA) tool [1]. We compared patient characteristics and used Fisher's exact test and a survival analysis to assess the primary endpoint of inpatient death. Results/UNASSIGNED:HBO2 therapy was offered to 36 patients, of which 24 received treatment and 12 did not receive treatment. Patients who did not receive treatment were significantly older (p ≺ 0.01) and had worse baseline hypoxia (p = 0.06). Three of the 24 (13%) patients who received treatment died compared to six of 12 (50%) patients who did not receive treatment (RR ratio: 0.25, p = 0.04, 95% CI: 0.08 to 0.83). In the survival analysis, there was a statistically significant reduction in inpatient mortality in the treatment group (HR: 0.19, p = 0.02, 95% CI: 0.05-0.74). However, after adjusting for age and baseline hypoxia, there was no difference in inpatient mortality (hazard ratio: 0.48, p = 0.42, 95% CI: 0.08-2.86). Conclusion/UNASSIGNED:The survival benefit of HBO2 therapy observed in our unadjusted analysis suggests that there may be therapeutic benefits of HBO2 in treating COVID-19 hypoxia as an adjunct to standard care.

INTRODUCTION/UNASSIGNED:In order to obtain FDA Marketing Authorization for aid in the diagnosis of concussion, an eye tracking study in an intended use population was conducted. METHODS/UNASSIGNED:Potentially concussed subjects recruited in emergency department and concussion clinic settings prospectively underwent eye tracking and a subset of the Sport Concussion Assessment Tool 3 at 6 sites. The results of an eye tracking-based classifier model were then validated against a pre-specified algorithm with a cutoff for concussed vs. non-concussed. The sensitivity and specificity of eye tracking were calculated after plotting of the receiver operating characteristic curve and calculation of the AUC (area under curve). RESULTS/UNASSIGNED:= 282) was 31.6%. CONCLUSION/UNASSIGNED:A pre-specified algorithm and cutoff for diagnosis of concussion vs. non-concussion has a sensitivity and specificity that is useful as a baseline-free aid in diagnosis of concussion. Eye tracking has potential to serve as an objective "gold-standard" for detection of neurophysiologic disruption due to brain injury.

Background: We recently implemented the Age-Friendly Health System's 4Ms (What Matters, Medication, Mentation, and Mobility) framework in New York City Health + Hospitals/Bellevue Hospital Center's Geriatrics clinic to improve care of older adults.
Method(s): We examined the impact of 4Ms assessment on patient care and changes in care processes through specific interventions triggered after assessment. We conducted chart reviews of patient visits during March 2021, the first month of 4Ms implementation and identified interventions made during these visits. To assess "What Matters" providers asked "What Matters the most to you;" potentially inappropriate Medications (PIM) were identified using the Beers list; Mentation was evaluated using the Mini-Cog; and Mobility was determined using timed up and go (TUG) test. We used descriptive statistics to characterize findings.
Result(s): Among the 121 patients who had 4Ms assessment in March 2021, 85% (n=103) were asked "What Matters;" providers reviewed Medications for almost all (n=118; 98%) and conducted a Mini-Cog for 64% (n=78). Most not cognitively assessed were either previously screened (n=11; 9%) or had dementia (n=12; 10%). Providers used the TUG test for 87% (n=105). What Mattered to patients most commonly was "getting better" (n=24; 23%). There were 39 (33%) patients with potentially inappropriate Medications (including proton pump inhibitors, gabapentinoids, and NSAIDS) of which 10 (26%) Medications were either discontinued or reduced. Other interventions included further cognitive evaluation (n=2) and home care referrals (n=2) among 14 (18%) with an abnormal Mini- Cog. Among the 51 (42%) patients with an abnormal TUG, providers intervened for 19 (37%) with devices, referrals or home services.
Conclusion(s): The adoption of 4Ms assessment during routine visits identified issues with Medications, Mentation and Mobility, triggering several interventions for common geriatric conditions. 4Ms assessment is a helpful strategy to organize geriatric care, routinely assess patients for common geriatric syndromes, and improve care. Future directions include prioritizing interventions integrated with "What Matters" to maintain patient-centered care

Background: Neighborhood disadvantage influences health outcomes regardless of personal economic status, illustrating the importance of neighborhood context on health. The Area Deprivation index (ADI) establishes a ranking system of U.S. neighborhoods on state and national levels based on 17 neighborhood factors. Using data from an ongoing study of patients with dual diagnoses of diabetes and dementia, we investigated the relationship between ADI and diabetic outcomes, including glycemic control, blood pressure, and dementia severity.
Method(s): We conducted descriptive and bivariate statistics using 3 years of health record data from patients of NYU Langone Health. We included patients >=65 years, with ADRD and DM, and on DM medication. In addition to demographic measures and NY home addresses, we collected hemoglobin A1c, blood pressure, and assessed dementia severity, surveying proxies with the dementia severity rating scale (DSRS). We used ArcGIS and ADI data to link patient addresses to an ADI score. We stratified the sample into two groups: a low deprivation group with ADI scores 1-5, and a high deprivation group with ADI scores 6-10.
Result(s): Of those meeting inclusion criteria (n=996), most were over 75 years (73.5%), female (60.1%), white (71.2%), and not Hispanic or Latino (72.4%). Mean patient age was 81.3; standard deviation (SD): 7.6. More than 50% of patients had an NY state ADI score of 1, 2 or 3 out of 10, indicating that the majority of the population lived in neighborhoods of less disadvantage. 83.4% (n=831) of the population fell into the low deprivation group. There were no differences in hemoglobin A1c (7.09 vs. 7.01) or dementia severity (25.5 +/- 0.8 vs. 22.4 +/- 2.0) between low and high deprivation groups, respectively. However, systolic blood pressure was greater in high deprivation individuals (132.4 +/- 19.3 mm Hg vs. 128.6 +/- 18.2; p=0.02).
Conclusion(s): The ADI in this study was associated with blood pressure but not diabetic control or dementia severity. Less heterogeneity in disadvantage limited our ability to detect this potential social determinant of health. In a city, where neighborhood disadvantage changes from block to block, the influence of environment on health may be more difficult to detect

Background: Clinical trials are important to improve evidencebased care for persons living with dementia (PLWD) and for their care partners (dyads). Barriers to research recruitment are numerous, including care partners concerns' of ill health, cognitive impairment (CI) severity, and denial of need. The aim of this study is to determine whether a performance- or informant-based screening test for CI is associated with trial enrollment and whether mode of administration influences one's decision to participate.
Method(s): We used cross-sectional data from patients and caregivers who visited the EDs of New York University (NYU) and Indianapolis University (IU) during screening for the Program of Intensive Support in Emergency Departments (ED) for Care Partners of Cognitively Impaired Patients (POISED), which is testing a care management intervention. We offered CI screening to patients >75 years using the Mini-Cog and if unable to do this, we offered their care partners the Short Portable Informant Questionnaire of Cognitive Decline (IQ-CODE). We used chi-square tests and logistic regression to determine whether likelihood of enrollment differed between screening tests and mode of administration: in-person versus telephone.
Result(s): We screened 8860 patients or care partners (dyads) between 3/3/2018-4/1/2021, of which n=2840 at NYU and n=660 at IU had positive screens. Of these 3500 dyads, 2142 had a positive Mini-Cog (<2) and 1358 had a positive IQ-CODE (>3.40). We enrolled 13.9% (n=297) of positive Mini-Cogs and 14.5% (n=309) of positive in-person IQ-CODEs. During the pandemic we conducted all IQCODEs by phone and enrolled 34% (n=196) of those who screened positive. Adjusting for age, sex, and gender, compared to Mini-Cog screening, only those having positive IQCODES by phone were more likely to enroll (adjusted odds ratio (AOR): 3.75 (95% CI: 2.76, 5.11).
Conclusion(s): Higher enrollment using informant-based telephone screening after discharge suggests that care partner recognition of a problem and perhaps having less distraction from the ED visit may increase trial enrollment. Whether the pandemic was the predomant factor encouraging enrollment is unknown