Examining How the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model Improves Health Equity for Underserved Communities and Safety Net Hospitals in New York State.

Safety net hospitals (SNHs) are essential to our healthcare ecosystem, providing quality healthcare to underserved communities. These institutions offer specialized services and acute medical care to populations facing structural or systemic healthcare barriers. However, for decades, the NYS Medicaid program reimbursed hospitals less than the cost of care, resulting in several independent SNHs becoming financially distressed, with many facing closure.

Safety-net Hospitals in Brooklyn, New York: A Review.

Safety-net hospitals (SNHs) provide health care services to individuals regardless of their ability to pay. These hospitals serve Medicaid recipients, the uninsured, and people with limited access to health care due to their socioeconomic status, race, or ethnicity. In addition to providing health care to the most vulnerable, SNHs are crucial in training the next generation of clinicians.

Association of opioid exposure during intensive care unit stays with post-discharge opioid use: A retrospective study and literature review.

Objective: To evaluate whether pain management strategies within intensive care unit (ICU) settings contribute to chronic opioid use upon hospital discharge in opioid-naive patients requiring invasive mechanical ventilation.

Design: A retrospective, observational study.

Setting: An 18-bed mixed ICU at a community teaching hospital located in Brooklyn, New York.

AHA telemetry guidelines improve telemetry utilization in the inpatient setting.

Objectives: Overuse of telemetry among hospitalized patients results in poor patient care and wasted health care dollars. Guidelines addressing telemetry use have been developed by the American Heart Association (AHA) and are effective when applied to specific clinical practices and high-value care. The purpose of our intervention was to facilitate more effective utilization of telemetry in our hospital.

Treatment With Tocilizumab for Patients With COVID-19 Infections: A Case-Series Study.

Tocilizumab (TCZ), a humanized monoclonal antibody targeting the interleukin-6 receptor, holds the potential for treating coronavirus disease 2019 (COVID-19) patients, particularly those at high risk of cytokine storm syndrome. However, data regarding the clinical impact of treatment with TCZ in patients with COVID-19 are limited. This study was conducted to evaluate the safety and effectiveness of TCZ as an adjunct therapy for the treatment of severe COVID-19 infection.

Clinical and economic impact of the use of dexmedetomidine for sedation in the intensive care unit compared to propofol.

Background Despite the advantages of dexmedetomidine (DEX) over propofol (PRO) including minimal respiratory depression and the potential for preventing and/or treating intensive care unit (ICU) delirium, PRO has been the preferred agent due to its lower cost. However, the acquisition cost of DEX has considerably decreased as a generic version of DEX has recently become available. Objective To evaluate clinical and economic outcomes of DEX-based sedation compared to PRO in the ICU.

Characterization of Critically Ill COVID-19 Patients at a Brooklyn Safety-Net Hospital.

Background The novel coronavirus disease 2019 (COVID-19) pandemic continues to spread across the country with over 3 million cases and 150,000 deaths in the United States as of July 2020. Outcomes have been poor, with reported admission rates to the intensive care team of 5% in China and mortality among critically ill patients of 50% in Seattle. Here we explore the disease characteristics in a Brooklyn safety-net hospital affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

Clostridioides difficile infection in US hospitals: a national inpatient sample study.

Background: Hypervirulent strains of Clostridioides difficile have altered the landscape of hospital and community outbreaks. We aim to examine and compare spatiotemporal trends, incidence, hospital teaching status, mortality, and cost associated with hospital-acquired Clostridioides difficile infection (HCDI) and community-acquired Clostridioides difficile infection (CCDI).

Methods: Retrospective cohorts were studied using data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) from 2006 to 2015.

Practice measures for controlling and preventing hospital associated Clostridium difficile infections.

(CD) is the most common cause of nosocomial diarrhea. We aim to highlight practice measures for controlling and preventing infections (CDI) in the hospital setting. Electronic databases including PubMed, MEDLINE, Google Scholar, ClinicalTrials.

Community-acquired Clostridium difficile: epidemiology, ribotype, risk factors, hospital and intensive care unit outcomes, and current and emerging therapies.

Background: The epidemiological landscape of Clostridium difficile infection (CDI) has changed over the past 30 years.

Aim: To review studies of CDI in the community setting.

Methods: Electronic databases including PubMed, MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.

Evaluation of the Clinical Utility of Routine Daily Chest Radiography in Intensive Care Unit Patients With Tracheostomy Tubes: A Retrospective Review.

Background: The utilization of imaging procedures is under scrutiny due to high costs and radiation exposure to patients and staff associated with some radiologic procedures. Within our institution's intensive care unit (ICU), it is common for patients to undergo chest radiography (CR) not only immediately following tracheostomy tube placement but also on a daily basis, irrespective of the patient's clinical status. We hypothesize that the clinical utility of performing routine daily CR on patients with tracheostomy tubes is low and leads to unnecessary financial cost.

Hypertriglyceridemic Pancreatitis Caused by the Oral Contraceptive Agent Estrostep.

Norethindrone acetate/ethinyl estradiol (Estrostep; Warner Chilcott, Rockaway, New Jersey) is an "estrophasic" type of oral contraceptive, which combines a continuous low progestin dose with a gradually increasing estrogen dose. In clinical trials, this medication failed to produce clinically significant changes in serum lipid levels. We report a case of severe hypertriglyceridemia-induced acute pancreatitis in a 24-year-old woman caused by Estrostep, occurring nearly 10 years after she began using the drug.

Integrating Palliative Care into Critical Care: A Quality Improvement Study.

Background: Many terminally ill patients experience an increasing intensity of medical care, an escalation frequently not consistent with their preferences. In 2009, formal palliative care consultation (PCC) was integrated into our medical intensive care unit (ICU). We hypothesized that significant differences in clinical and economic outcomes exist between ICU patients who received PCC and those who did not.

Cocaine-induced agitated delirium: a case report and review.

Cocaine use continues to be a major public health problem in the United States. Although many of the initial signs and symptoms of cocaine intoxication result from increased stimulation of the sympathetic nervous system, this condition can present as a spectrum of acuity from hypertension and tachycardia to multiorgan system failure. Classic features of acute intoxication include tachycardia, arterial vasoconstriction, enhanced thrombus formation, mydriasis, psychomotor agitation, and altered level of consciousness.

Malignant nerve sheath tumor of the spinal accessory nerve: a unique presentation of a rare tumor.

Background: Malignant peripheral nerve sheath tumors (MPNSTs), sarcomas originating from tissues of mesenchymal origin, are rare in patients without a history of neurofibromatosis.

Case Report: We report a case of an MPNST of the spinal accessory nerve, unassociated with neurofibromatosis, which metastasized to the brain. The tumor, originating in the intrasternomastoid segment of the spinal accessory nerve, was removed.

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act.

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes.

The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review.

The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist.

Methotrexate-induced posterior reversible encephalopathy syndrome.

What Is Known And Objective: Posterior reversible encephalopathy syndrome (PRES) is described clinically as an acute neurologic deterioration characterized by headache, change in mental status and seizures. Although the mechanism(s) for this syndrome is not fully understood, PRES results from vasogenic edema in areas of the brain supplied by the posterior circulation. Methotrexate (MTX)-induced neurotoxicity is a well-known complication of therapy in the paediatric population but is uncommon in adults.

Gender is a risk factor for lung cancer.

Results of epidemiological studies suggest that, after one controls for the number of cigarettes smoked, women have a three times higher risk of getting lung cancer than men. Although the mechanism(s) explaining this gender-dependent difference in lung cancer risk is not known, it is thought that endocrine factors may play an important role. Normal human bronchial epithelial cells contain estrogen receptors and synthesize 17β-estradiol (E(2)) and estrone (E(1)), which can undergo further metabolism into the catechol estrogens, 4-hydroxyestradiol (4-OHE(2)) and 4-hydroxyestrone (4-OHE(1)), respectively.

Investigation of critical care unit utilization and mortality in patients infected with Clostridium difficile.

Background: A nationwide increase in the rate and severity of Clostridium difficile-associated disease may reflect infection with a virulent strain characterized by polymerase chain reaction as ribotype 027 (NAP1/B1).

Hypothesis: The high prevalence of ribotype 027 at our institution would allow investigation of the risk of mortality and admission to the intensive care unit (ICU) associated with C difficile infection.

Methods: In a retrospective cohort study, we identified 108 patients with positive enzyme-linked immunosorbant assay tests for C difficile toxins over a 6-month period and compared them to 108 patients who were suspected to have C difficile but with negative toxin assays.

Use of Tris-hydroxymethyl aminomethane in severe lactic acidosis due to highly active antiretroviral therapy: a case report.

Background: Lactic acidosis is a rare, yet life-threatening adverse drug effect of highly active antiretroviral therapy (HAART), specifically stavudine and lamivudine. These nucleoside analogue reverse transcriptase inhibitors (NRTIs) are commonly used to treat patients infected with the human immunodeficiency virus (HIV).

Case: We report the use of Tris-hydroxymethyl aminomethane (THAM) to treat severe lactic acidosis due to HAART in a 50-year-old African-American woman.

Fulminant liver failure secondary to haemorrhagic dengue in an international traveller.

Dengue infections are caused by a single-stranded RNA virus, which has four serotypes (DEN 1-4); mosquitoes of the genus Aedes serve as vectors of transmission. Risk factors for dengue infection are related to both the host and virus. Age, gender, immune status, and genetic background of the host all contribute to the severity of dengue infection.

Gender and lung cancer.

Although lung cancer is the leading cause of cancer death among men and women in the United States, female smokers appear to be at increased risk. After controlling for the number of cigarettes smoked, female sex imparts a significant, independent risk for most histologic types of lung cancer. Cigarette smoking, genetics, and endocrine factors may interact to contribute to the disparity in lung cancer risk between the sexes.