Faculty Bibliography

BACKGROUND:Flow-diverter stents (FDS) have become the standard of care for a wide range of intracranial aneurysms, but their efficacy/safety in the context of recurrent/recanalized aneurysms following stent-assisted coiling (SAC) is not well established. We evaluate the outcomes of FDS retreatment in a large multicenter cohort. METHODS:We retrospectively analyzed data from 118 patients across 22 institutions who underwent FDS retreatment for recurrent/persistent aneurysms after SAC (2008-22). The primary outcome was angiographic occlusion status at last follow-up, categorized as complete (100%), near-complete (90-99%), or incomplete (<90%) occlusion. Secondary outcomes included procedural complications and clinical outcomes measured by the modified Rankin Scale (mRS). RESULTS:A total of 118 patients (median age 57, 74.6% female) with median follow-up of 15.3 months were identified. Complete occlusion was achieved in 62.5% and near-complete occlusion in 25%. FDS deployment within the pre-existing stent was successful in 98.3% of cases. Major complications occurred in 3.4% of cases, including postoperative aneurysmal rupture with resultant mortality (1.6%) and thromboembolic events with long-term disability (1.6%). Favorable clinical outcomes (mRS 0-2) were observed in 95.1% of patients. Wider aneurysm neck diameter was a significant predictor of incomplete occlusion (adjusted OR (aOR) 1.23 per mm, P=0.044), with male sex trending towards association with non-occlusion (aOR 3.2, P=0.07), while baseline hypertension was associated with complete occlusion (aOR 0.32, P=0.048). CONCLUSIONS:FDS treatment for recurrent/residual aneurysms after SAC represents a viable treatment option for these challenging cases with acceptable safety and reasonable occlusion rates, although lower than de novo FDS occlusion rates.

OBJECTIVE:Social determinants of health (SDOH) may impact the incidence of Respiratory Syncytial Virus (RSV) infection and the uptake of vaccinations in pregnancy. The objective of this study is to identify contributors to disparities in RSV vaccination in pregnancy. DESIGN/METHODS:This is a retrospective cohort study of patients delivering at term within three hospitals during February and March 2024, comparing pregnant patients identified as receiving vs not receiving RSV vaccinations. This period and gestational age were chosen to include patients who would have qualified for RSV vaccination administration. Vaccination status was extracted from standardized admission templates where these variables were recorded as discrete fields. Patients without RSV vaccination information were excluded. Sociodemographic factors, COVID vaccination status, and delivery campus were evaluated. Outcomes were analyzed using chi-squared, t-test, and McNemar test. RESULT/RESULTS:2181 patients met inclusion criteria and RSV vaccination information was available for 1548 patients (71%) with a 14% vaccination rate. Compared to those not vaccinated (n=1332), RSV vaccinated patients (n=216) were more likely to be older (30.7 vs 34.8, p<0.001), have private insurance (42% vs 85%, p<0.001), speak English (82% vs 95%, p<0.001), and deliver at our regional perinatal center (26% vs 77%, p<0.001). 50% of RSV vaccinated patients had a history of COVID vaccination compared to 33% of those not vaccinated against RSV (p<0.001). CONCLUSIONS:SDOH were associated with differences in RSV vaccination status. In addition, patients without RSV vaccination were less likely to have had COVID vaccination. These findings highlight the need to address SDOH to increase vaccination rates for vulnerable populations.

BACKGROUND:Care transitions from the emergency department (ED) to the community represent a critical period that can significantly impact clinical outcomes of older adults, yet there is a lack of standardized tools to measure patient-reported experiences and outcomes during this transition. Our objective was to develop and validate the Patient-Reported Outcome Measure-Older adult care Transitions in the ED (PROM-OTED) tool to measure care transition outcomes within 4-10 days after ED discharge. METHODS:Older adults (65+ years) discharged from four EDs were enrolled between November 2021 and April 2024 in a multiphase process: qualitative interviews, item generation, member checking, cognitive debriefing, technical expert panel review, and psychometric evaluation and validation. We employed descriptive statistics, item analysis, interitem correlation, and factor analyses to assess the tool's validity and reliability. RESULTS:Across all phases, we enrolled 290 older adults. The final 18-item PROM-OTED tool included items that addressed understanding of discharge instructions, medication management, follow-up care, and quality of life. The tool demonstrated feasibility with a mean (±SD) completion time of 4.97 (±3.04) min and was able to be administered electronically or via telephone. The tool additionally demonstrated excellent internal consistency (Cronbach's alpha 0.9376, McDonald's omega 0.9988) and good test-retest reliability (r = 0.8437). Exploratory factor analysis supported a robust factor structure and significant correlations between the PROM-OTED tool with the Care Transitions Measure-3, a general measure of hospital discharge quality of care, support its concurrent validity. CONCLUSIONS:The PROM-OTED tool is a reliable and preliminarily valid instrument for use during the immediate post-ED period, with potential clinical applications in enhancing discharge practices and assessing care transition outcomes of older adults during observational or interventional studies.

BACKGROUND:Organ Procurement and Transplantation Network (OPTN) policy requires 2 years of follow-up for living kidney donors (LKDs); however, many transplant hospitals struggle to meet this requirement. We developed and tested a mobile health (mHealth) system for LKD follow-up in a pilot randomized-controlled trial (RCT). METHODS:LKDs were randomly assigned to either the intervention (mHealth + standard of care) or control arm (standard of care). We assessed OPTN policy-defined completeness and timeliness of 6-month, 1-year, and 2-year follow-ups. Four hundred LKDs were enrolled in the study (June 2018 to February 2021). RESULTS:At 6-month follow-up, a higher proportion of the intervention arm participants completed composite visits (97.5% vs. 91.5%, p = 0.01). Both arms had similar compliance rates at 1- and 2-year follow-up (92.0% vs. 89.5%, p = 0.49, and 66.5% vs. 65.0%, p = 0.83). Intervention arm participants completed 6-month follow-up 11 days earlier than their counterparts (p = 0.009). CONCLUSION/CONCLUSIONS:mHealth technologies improved 6-month follow-up, but did not impact 1- and 2-year LKD follow-up in this single-center RCT. Other strategies, such as providing services beyond data collection, may be necessary to improve donor engagement and support LDK's long-term follow-up.

OBJECTIVE:Poverty and systemic racism within rare intertwined. Children of marginalized racial and ethnic identities experience higher levels of poverty and adverse psychiatric outcomes. Thus, in models of poverty and neurodevelopment, race and ethnicity-as proxies for exposure to systemic disadvantage-are regularly considered confounders. Recently, however, some researchers claimed that using race and ethnicity as confounders is statistically dubious, and potentially socially damaging. Instead, they argue for the use of variables measuring other social determinants of health (SDoH). We explore this approach. METHOD/METHODS:Data are from 7,836 10-year-olds in the Adolescent Brain and Cognitive Development study. We fit mixed regression models for the association of household poverty measures with psychiatric symptoms, magnetic resonance imaging-derived (MRI) cortical measures, and cognition with and without (1) race and ethnicity adjustment; (2); poverty-by-race and ethnicity interaction terms and (3) alternative SDoH variables. Propensity-based weights were used to calibrate the sample to key US demographics. RESULTS:For psychiatric and cognitive outcomes, poverty-outcome relationships differed across racial and ethnic groups (poverty-by-race-and-ethnicity interaction p<0.05). For MRI outcomes, adjusting for race and ethnicity changed the estimate of poverty's impact. Alternative SDoH adjustment could not fully account for the impact of race and ethnicity on the associations explored. CONCLUSION/CONCLUSIONS:Poverty and race and ethnicity combine to influence neurodevelopment. Results suggest effects of poverty are generally inconsistent across race and ethnicity, which supports prior research demonstrating the non-equivalence of SDoH indicators by race and ethnicity. Studies exploring these relationships should assess interaction between poverty and race and ethnicity and/or stratify when appropriate. Replacing race and ethnicity with alternative SDoH may induce bias.

Electronic health records (EHRs) present opportunities to study uterine fibroids uterine fibroids and endometriosis within diverse populations. When using EHR data, it is important to validate outcome classification via diagnosis codes. We performed a validation study of three approaches (1: ICD-10 code alone, 2: ICD-10 code + diagnostic procedure, and 3: ICD-10 code + all diagnostic information) to identify incident uterine fibroids and endometriosis patients among n=750 NYU Langone Health 2016-2023. Chart review was used to determine the true diagnosis status. When using a binary classification system (incident vs. non-incident patient), Approaches 2 and 3 had higher positive predictive values (PPVs) for uterine fibroids (0.86 and 0.87 vs. 0.78) and for endometriosis (0.70 and 0.73 vs. 0.66), but Approach 1 outperformed the other two in negative predictive values (NPVs) for both outcomes. When using a three-level classification system (incident vs. prevalent vs. disease free patients), PPV for prevalent patients was low for all approaches, while PPV/NPV of disease-free patients was generally above 0.8. Using ICD-10 codes alone yielded higher NPVs but resulted in lower PPVs compared with the other approaches. Continued validation of uterine fibroids/endometriosis EHR studies is warranted to increase research into these understudied gynecologic conditions.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Lung cancer is the leading cause of cancer death worldwide and is often diagnosed at a late stage when treatment options are limited. Lung cancer screening (LCS) via low-dose computed tomography (LDCT) has been shown to reduce mortality rates in high-risk individuals. However, utilization remains low, particularly among those with lower socioeconomic status (SES) and language barriers. This narrative review aims to summarize pertinent literature which focuses on perspectives and experiences of Spanish-speaking populations involved in lung cancer screening and evaluation programs. A secondary aim is to explore cultural factors and beliefs which affect perceptions of underserved populations in lung cancer screening. KEY CONTENT AND FINDINGS/UNASSIGNED:Lung cancer screening with LDCT; Hispanic/Latino population; Lung cancer; Barriers, Interests, and Emotions that play a role in beliefs about cancer and lung cancer screening; Underserved communities. METHODS:Six authors extracted articles from the PubMed, Google Scholar, and Cochrane databases. The inclusion and exclusion criteria were designed to ensure the appropriate selection of studies that align with the primary aim of understanding the cultural and systemic barriers to lung cancer screening (LCS) within the Spanish-speaking population in the United States over the past two decades. Case reports and systematic reviews were excluded to facilitate a more comprehensive analysis rather than focusing on individual cases or summaries of existing literature. Additionally, studies involving patients with advanced lung cancer were excluded, as the focus of this narrative review is to recognize the barriers to early detection of the disease, rather than the management of advanced-stage lung cancer or its treatment. The inclusion criteria were as follows: Qualitative studies, cross-sectional studies, randomized trials. Studies performed in the United States. Studies done from 2005-2024. Studies that discuss barriers to and perceptions of lung cancer screening in underserved populations including patients who identified as Latino and who speak Spanish. Studies involving lung cancer patient also describing ways cultural barriers and beliefs affect the perception of cancer screening. The exclusion criteria were as follows: Case reports and systematic reviews. Studies performed outside the United States. Studies that did not include lung cancer screening. Studies on patients with advanced lung cancer.

BACKGROUND/IMPORTANCE/BACKGROUND:Chronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief. OBJECTIVES/OBJECTIVE:To evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia. EVIDENCE REVIEW/METHODS:A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10. FINDINGS/RESULTS:Seventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3-6 months) and long-term (greater than 6 months) follow-up. SMDs were -2.73 (95% CI -3.45 to -2.01), -3.22 (95% CI -2.82 to -1.45), -1.86 (95% CI -2.58 to -1.15) at 3 months, 3-6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated 'very low' certainty of evidence across all outcomes. CONCLUSIONS:Non-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia. PROSPERO REGISTRATION NUMBER/UNASSIGNED:CRD42024506056.

PURPOSE/OBJECTIVE:We describe a case of bilateral, multiple, branch retinal artery occlusions (BRAO) associated with carotid webs. METHODS:A thorough chart review was conducted for the patient. Relevant literature was systematically reviewed. RESULTS:Eight cases of fibromuscular dysplasia (FMD) associated with retinal artery occlusions have been reported. Two additional cases of FMD with other ocular involvement have been described. No cases of carotid webs associated with retinal artery occlusions were found. CONCLUSION/CONCLUSIONS:Carotid webs, an uncommon variant of FMD, are a recognized causative etiology of arterial, ischemic stroke. The case described here of bilateral, multifocal BRAOs represents a unique manifestation of this variant of FMD. This diagnosis should be considered in the setting of an otherwise unrevealing BRAO workup, as recognition of this association may be sight and life-saving.

PURPOSE/OBJECTIVE:Interproximal contact loss (ICL) is considered a prevalent complication for a tooth abutting an implant restoration. While numerous potential causes for ICL have been presented, there is no consensus. A review of the current literature with a focus on possible risk factors was performed. MATERIALS AND METHODS/METHODS:A PubMed search using keywords "implant OR dental implants OR implant supported prosthesis AND proximal contact loss OR ICL OR loss of interproximal contact OR open contact OR interproximal open contact OR adjacent natural teeth" resulted in 81 citations, 9 of which were relevant to the focus question. Additional references were culled from the reference lists in the identified articles. Systematic reviews, case series, and case reports were reviewed with a focus on causation, association, or correlation. RESULTS:Eight systematic reviews and 14 case series were reviewed. The prevalence of ICL has been reported to be as low as 16% and as high as 66%. ICL was more common on the mesial side of implants and when a tooth abuts a splinted implant restoration. The absence of a uniform definition to accurately describe an interproximal (IP) contact and an open IP contact is demonstrated in the literature. A lack of standardized measurement strategies that relate to a needed consensus definition further exacerbates the broad range of reported results regarding ICL. The lack of controls for almost all the ICL literature makes it difficult to draw conclusions and comparisons to unrestored, natural tooth IP contacts and the prevalence of ICL in this patient population. As a result, the available studies are inadequate to support a causal theory and the potential risk factors associated with ICL. CONCLUSIONS:There is a large range of reported prevalence for IP contact loss. ICL is more common when a natural tooth abuts a splinted implant restoration. ICL is more common on the mesial, as opposed to the distal, of an implant retained restoration. Consensus in the definition and measurement strategies for ICL needs to be established to provide standardized terminology and methodology. Potential risk factors such as occlusion, restorative material, and tooth contact area need to be investigated.