Faculty Bibliography

Background: Among older adults with Medicare, three-quarters made an ED visit in the last six months of life, and a third made a visit in the last month of life. Objectives: Describe ED and hospital use for those with advanced cancer, cardiac or pulmonary disease over the study period, including the proportions of ED visits by these patients in reference to the overall ED population. Second, we sought to describe the survival rates for these patients after their index ED visit, including the 30, 60, and 180 day along with their median survival. Methods: We used the New York Statewide Planning and Research Cooperative System (SPARCS), which provides comprehensive longitudinal information on in- and outpatient utilization that can be linked to the state death index. SPARCS and its ability to link medical claims data to the national death index makes it a unique setting in which to study ED use in such patients. Results: Our sample included all patients >18 years of age with at least one inpatient admission > 48 hours and an ICD-9 code consistent with advanced, incurable cancer, cardiac, and pulmonary diseases in New York State between 2005 and 2011 (N=193,145). The ED visit rate for our cohort increased yearly, from 1.97 visits/year in 2006, to 2.86 in 2011. The proportions of visits remained relatively similar over the study period (9.3%). 73% of the time, ED patients with advanced cancer were admitted; 14% of patients had an ICU stay during their hospitalization. Median survival for advanced cancer patients from the index ED visit was between 8.5 to 10.9 months during the study period. Such predictable mortality was observed in advanced cardiac / pulmonary disease group as well. (Table presented) Conclusion: There is a substantial proportion of patients with serious, life-limiting illness presenting to the ED. The subsequent inpatient health care utilization is high among these patients. There is a predictable mortality rates associated with the index ED visits for these patients. An ED visit may present a unique opportunity to capture these seriously ill patients with life-limiting illness to set their trajectory of end of life care

Background: The delivery of palliative care is not standard of care in most EDs. Preliminary data suggest that early palliative care consultation can decrease hospital length of stay and costs for select patients with advanced illness, and may extend life. Objectives: To compare quality of life, health care utilization, and survival for ED patients with advanced cancer randomized to EDinitiated palliative care consultation versus care as usual. Methods: DESI

BACKGROUND: To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request (CDMR), a fast-growing component of caesarean delivery in many nations. METHODS: We followed 1 019 576 nulliparous women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, kg/m(2) ), before pregnancy or during early pregnancy, was classified as underweight (<18.5), normal (18.5 to <23; reference), overweight (23 to <27.5), or obese (>/=27.5), consistent with World Health Organization guidelines for Asian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log-binomial regression. RESULTS: During the 18-year period, 404 971 (39.7%) caesareans and 93 927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR. Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. CONCLUSIONS: In a large Chinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that caesarean births will increase, unless there are changes in obstetrical practice.

AIM: We assessed the association of aortic valve sclerosis (AVS) with atherosclerotic risk factors and severity and complexity of coronary artery disease (CAD). METHODS: In this retrospective study, a total of 482 eligible patients were divided into 2 groups: AVS present and AVS absent. All major cardiovascular risk factors and coronary lesion characteristics were included. RESULTS: Age was the only independent predictor of AVS. AVS was not independently associated with the number of obstructive vessels, degree of lesion obstruction and SYNTAX score. CONCLUSION: AVS is probably a benign marker of age-related degenerative changes in the heart independent of the severity and complexity of CAD.

PURPOSE: The aim of this study was to examine prevalence and correlates of health-risk behaviors in 12- to 17.5-year-olds investigated by child welfare and compare risk-taking over time and with a national school-based sample. METHODS: Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were analyzed to examine substance use, sexual activity, conduct behaviors, and suicidality. In a weighted sample of 815 adolescents aged 12-17.5 years, prevalence and correlates for each health-risk behavior were calculated using bivariate analyses. Comparisons to data from NSCAW I and the Youth Risk Behavior Survey were made for each health-risk behavior. RESULTS: Overall, 65.6% of teens reported at least one health-risk behavior with significantly more teens in the 15- to 17.5-year age group reporting such behaviors (81.2% vs. 54.4%; p /=64 reported at least one health-risk behavior. The prevalence of smoking was lower than in NSCAW I (10.5% vs. 23.2%; p